Factors predicting cessation of status epilepticus in clinical practice: Data from a prospective observational registry (SENSE)

Abstract

Objective: To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables. Methods: Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni-and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE [GCSE]) and 12 hours (for non-GCSE) of initiating treatment. Results: Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non-GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE and 73% in non-GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of GCSE patients and 78% of non-GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment and in 342 non-GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that use of benzodiazepines as first treatment step and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups. Interpretation: In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This underdosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as a first treatment step.

Levetiracetam and brivaracetam: a review of evidence from clinical trials and clinical experience

“…130 A recent study on status epilepticus in eight German and Austrian emergency units revealed that LEV is used as a first-line agent sporadically with inferior efficacy compared with benzodiazepines. 131…”

Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

“…[1][2][3][4][5] Refractory SE (RSE) and superrefractory SE (SRSE) are characterized by the failure of first-, second-, and third-line therapy and, in the latter case, anesthetic therapy. It requires instant medical intervention and is accompanied by prolonged hospital stays and increased health care costs.…”

“…It requires instant medical intervention and is accompanied by prolonged hospital stays and increased health care costs. [1][2][3][4][5] Refractory SE (RSE) and superrefractory SE (SRSE) are characterized by the failure of first-, second-, and third-line therapy and, in the latter case, anesthetic therapy. 1,6 There are few controlled or randomized study data on RSE and SRSE, so that the basis of therapeutic management frequently relies on expert opinion, clinical reports, and pathophysiological assumptions arising from experimental data.…”

Anticonvulsive Drug Use in Status Therapy: Adults

“…Of note, randomized controlled trials showed no benefit of starting with an iv AED (PB, PHT) instead of a benzodiazepine (32), or to administer an iv AED (LEV) coupled with benzodiazepine as first-line treatment (Navarro et al 2016;Treiman et al 1998). A large European retrospective study including over a thousand of patients found no superiority of one particular benzodiazepines but demonstrated that use of benzodiazepines as first treatment step and higher cumulative dose of anticonvulsant independently predict SE cessation (Kellinghaus et al 2019), highlighting the importance to use benzodiazepines, at adequate dosage, at the beginning of an SE episode.…”