Prediction of Long-term Survival After Status Epilepticus Using the ACD Score

Roberg, Lars Egil; Monsson, Olav; Kristensen, Simon; Dahl, Svein Magne; Ulvin, Line Bédos; Taubøll, Erik; Strzelczyk, Adam; Knake, Susanne; Bechert, Lydia; Rosenow, Felix; Beier, Dagmar; Beniczky, Sándor; Krøigård, Thomas; Beier, Christoph P.

doi:10.1001/jamaneurol.2022.0609

Cited by 38 publications

(54 citation statements)

References 52 publications

(69 reference statements)

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“…The emergency treatment of prolonged epileptic seizures, seizure clusters and status epilepticus (SE) is required to be rapid and efficient, as ongoing epileptic activity may lead to neuronal damage and result in increased morbidity and mortality [1][2][3]. The ideal anticonvulsant agent for this purpose should be safe, easy to administer, and exhibit a long-lasting anti-seizure effect without relevant side effects.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability

et al. 2022

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Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA) A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.

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Section: Introductionmentioning

confidence: 99%

Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability

et al. 2022

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“…Patient identification and selection are shown in Figure 1, and the cohort has previously been reported in another study 23 . Data reporting complies with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines 24 .…”

Section: Methodsmentioning

confidence: 88%

“…The quantification of neurological deterioration after SE is difficult. We chose the established NIHSS in this and related studies 23,29 because it appeared to be the “least bad established score” available and covers mainly supratentorial functions 27 . We found a modified Rankin Scale and Barthel index, indicating that retrospective assessment of the neurological status using NIHSS provides meaningful results 23 .…”

Section: Discussionmentioning

confidence: 99%

“…We chose the established NIHSS in this and related studies 23,29 because it appeared to be the “least bad established score” available and covers mainly supratentorial functions 27 . We found a modified Rankin Scale and Barthel index, indicating that retrospective assessment of the neurological status using NIHSS provides meaningful results 23 . However, NIHSS has obvious shortcomings, such as the insufficient coverage of temporal lobe functions that are often affected after SE and the exaggeration of a critical illness neuropathy giving scores in all four extremities.…”

Section: Discussionmentioning

confidence: 99%

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Association of ictal imaging changes in status epilepticus and neurological deterioration

et al. 2022

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Objective In patients with status epilepticus (SE), the clinical significance of ictal changes on magnetic resonance imaging (MRI) is insufficiently understood. We here studied whether the presence of ictal MRI changes was associated with neurological deterioration at discharge. Methods The retrospective cohort comprised all identifiable patients treated at Odense University Hospital in the period 2008–2017. All amenable MRIs were systemically screened for ictal changes. Patient demographics, electroencephalography, seizure characteristics, treatment, and SE duration were assessed. Neurological status was estimated before and after SE. The predefined endpoint was the association of neurological deterioration and ictal MRI changes. Results Of 261 eligible patients, 101 received at least one MRI during SE or within 7 days after cessation; 43.6% (44/101) had SE due to non‐ or less brain‐damaging etiologies. Patients who received MRI had a longer duration of SE, less frequently had a history of epilepsy, and were more likely to have SE due to unknown causes. Basic characteristics (including electroencephalographic features defined by the Salzburg criteria) did not differ between patients with (n = 20) and without (n = 81) ictal MRI changes. Timing of MRI was important; postictal changes were rare within the first 24 h and hardly seen >5 days after cessation of SE. Ictal MRI changes were associated with a higher risk of neurological deterioration at discharge irrespective of etiology. Furthermore, they were associated with a longer duration of SE and higher long‐term mortality that reached statistical significance in patients with non‐ or less brain‐damaging etiologies. Significance In this retrospective cohort, ictal changes on MRI were associated with a higher risk of neurological deterioration at discharge and, possibly, with a longer duration of SE and poorer survival.

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“…Roberg et al 2 studied over 1000 adult cases of status epilepticus, and developed and validated the age, consciousness, duration (ACD) score, to predict neurological deficits, and in turn, 2-year survival from SE.…”

Section: Commentarymentioning

confidence: 99%