Impact of treatment on the short-term prognosis of status epilepticus in two population-based cohorts

Vignatelli, Luca; Rinaldi, Rita; Baldin, Elisa; Tinuper, Paolo; Michelucci, Roberto; Galeotti, M.; Carolis, P. De; D’Alessandro, Roberto

doi:10.1007/s00415-008-0635-y

Cited by 24 publications

(24 citation statements)

References 22 publications

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“…The most frequently used first-line treatment was phenytoin (145/474). It is possible that respondents were referring to in-hospital treatment only (we have no way of testing this) or that the failure to use first-line treatments in a timely fashion is more likely to result in refractory cases, and quality of treatment can affect the mortality in status epilepticus [30]. On this basis, we cannot exclude that the frequent departure from common guidelines in the first stage of the treatment of these cases has some effect in causing drug resistance.…”

Section: Discussionmentioning

confidence: 95%

Preliminary results of the global audit of treatment of refractory status epilepticus

Ferlisi

Hocker

Grade

et al. 2015

Epilepsy & Behavior

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Section: Discussionmentioning

confidence: 95%

Preliminary results of the global audit of treatment of refractory status epilepticus

Ferlisi

Hocker

Grade

et al. 2015

Epilepsy & Behavior

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“…For example, pre-existent comorbidities (modifiable) 123 , race (not modifiable) 2 , and hospital settings (modifiable) 124, 125 have received scarce attention to date. Duration of SE, emphasized in some studies 13, 18 , may actually reflect an early selection of SE forms that are intrinsically difficult to treat, rather than a modifiable risk factor.…”

Section: Areas Needing Researchmentioning

confidence: 99%

Management of refractory status epilepticus in adults: still more questions than answers

Rossetti

Lowenstein

2011

The Lancet Neurology

293

234

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Summary Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. RSE should be treated promptly to prevent morbidity and mortality; however, scarce evidence is available to support the choice of specific treatments. Major independent outcome predictors are age (not modifiable) and etiology (that should be actively targeted). Recent recommendations for adults, relying upon limited evidence, suggest that RSE treatment aggressiveness should be tailored to the clinical situation: to minimize ICU-related complications, focal RSE without major consciousness impairment might initially be approached more conservatively; conversely, early induction of pharmacological coma is advisable in generalized-convulsive forms. At this stage, midazolam, propofol or barbiturates represent the most used alternatives. Several other treatments, such as additional anesthetics, other antiepileptic or immunomodulatory compounds, or non-pharmacological approaches (electroconvulsive treatment, hypothermia), have been used in protracted RSE. Treatment lasting weeks or months may sometimes result in a good outcome, as in selected cases after cerebral anoxia and encephalitis. Well-designed prospective studies of this condition are urgently needed.

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“…Hospital stays are longer, and most survivors show significant deterioration on functional outcome measures; [37] one study estimated that only 20 % had returned to baseline function at discharge [23]. The association of NCSE with increased morbidity and mortality persists after controlling for age, etiology, neurologic exam, and organ dysfunction [38–41]. Delayed diagnosis and prolonged duration of NCSE are linked with higher morbidity and mortality [11].…”

Section: Review Of the Data And Choice Of Model Parametersmentioning

confidence: 99%

Calculating the Risk Benefit Equation for Aggressive Treatment of Non-convulsive Status Epilepticus

et al. 2012

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Objective To address the question: does non-convulsive status epilepticus warrant the same aggressive treatment as convulsive status epilepticus? Method We used a decision model to evaluate the risks and benefits of treating non-convulsive status epilepticus with intravenous anesthetics and ICU-level aggressive care. We investigated how the decision to use aggressive versus non-aggressive management for non-convulsive status epilepticus impacts expected patient outcome for four etiologies: absence epilepsy, discontinued antiepileptic drugs, intraparenchymal hemorrhage, and hypoxic ischemic encephalopathy. Each etiology was defined by distinct values for five key parameters: baseline mortality rate of the inciting etiology; efficacy of non-aggressive treatment in gaining control of seizures; the relative contribution of seizures to overall mortality; the degree of excess disability expected in the case of delayed seizure control; and the mortality risk of aggressive treatment. Results Non-aggressive treatment was favored for etiologies with low morbidity and mortality such as absence epilepsy and discontinued antiepileptic drugs. The risk of aggressive treatment was only warranted in etiologies where there was significant risk of seizure-induced neurologic damage. In the case of post-anoxic status epilepticus, expected outcomes were poor regardless of the treatment chosen. The favored strategy in each case was determined by strong interactions of all five model parameters. Conclusions Determination of the optimal management approach to non-convulsive status epilepticus is complex and is ultimately determined by the inciting etiology.

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Impact of treatment on the short-term prognosis of status epilepticus in two population-based cohorts

Abstract: In addition to previously known prognostic factors, epidemiological comparison of mortality rates of SE between different regions must also consider the quality of treatment.

Cited by 24 publications

References 22 publications

Preliminary results of the global audit of treatment of refractory status epilepticus

Preliminary results of the global audit of treatment of refractory status epilepticus

Management of refractory status epilepticus in adults: still more questions than answers

Calculating the Risk Benefit Equation for Aggressive Treatment of Non-convulsive Status Epilepticus

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