Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus

Abstract

New antiepileptic drugs (AEDs) are increasingly applied in second-line therapy of status epilepticus (SE). In our study, we analyzed the impact of the choice of second-line AEDs on the course and prognosis of SE. Methods: This retrospective single-center study used data of an 8 year cohort of SE in adults from 2007 to 2014. Based on the year of market introduction with a cutoff at 1990, we classified AEDs as traditional or new. Prescription pattern associated differences in prognosis were measured through univariate and multivariable analysis of 3 endpoints: occurrence of refractory SE (RSE), functional outcome in survivors to discharge (good: mRS at discharge < 3 or identical to admission mRS; otherwise poor), and in-hospital mortality. Results: From 362 SE episodes during the study period, 222 episodes were included into the study, among those 150 episodes treated with new and 72 with traditional AEDs. Use of new AEDs increased during the study period. After adjustment for confounders, treatment with new AEDs was on the one hand associated with higher rate of RSE occurrence (OR 1.95, 95 % CI 1.05-3.62, p = 0.03), but, on the other hand, also with better functional outcome at discharge (OR 2.64, 95 % CI 1.16-6.00, p = 0.02), while it was not an independent predictor of inhospital mortality (OR 0.88, 95 % CI 0.33-2.33, p = 0.80). Conclusion: Our observation that new AEDs may be associated with a higher rate of RSE development and relatively better functional outcome when adjusted for the premorbid mRS needs confirmation in prospective studies.

Does diabetes mellitus affect the safety profile of valproic acid for the treatment of status epilepticus? A retrospective cohort study

“…In our study, continuous or repeated infusions of VPA were not independently associated with mortality in either the total cohort or the diabetic group. This observation compares well with other investigations in which older age and a more severe etiology of SE rather than the choice of anticonvulsive treatment strategies predicted mortality [ 3 , 37 ]. Similar to others [ 3 , 38 , 39 ], the potentially fatal etiology was the strongest predictive factor for mortality in different regression models in the present study (OR = 8.177; 95% CI: 3.776–17.7107; p < 0.001).…”

Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: An observational cohort study

“…Our study provides new insights into the management and clinical impact of mechanical ventilation in adult patients in whom SE has been successfully terminated. Whereas several studies have studied treatment measures during SE [30][31][32][33][34][35][36][37][38][39] and uncovered various complications emerging during the course of ongoing seizures, 1,3,4,30,32,[40][41][42] only few studies have focused on post-SE care and its clinical impact on course and outcome once SE is terminated. 2 At first glance, it seems not surprising that in our study, SE patients supported by mechanical ventilation were more severely ill, had less recovery to their premorbid function, and higher mortality compared to SE patients without ventilation.…”

Comparative effectiveness-safety of conventional versus newer antiepileptics in epileptic patients in a tertiary care hospital, India

“…The AEDs have been divided as per the year of market introduction before or after 1990 into newer and conventional [8]. Numerous studies on the effectiveness of conventional and newer AEDs have failed to show a significant difference.…”