Studienprotokoll: Register zur Prognose akut-symptomatischer Anfälle (PROSA-Register) – eine prospektive multizentrische Beobachtungsstudie

Herzig-Nichtweiß, Julia; Salih, Farid; Berning, Sascha; Malter, Michael P.; Lochner, Piergiorgio; Wittstock, Matthias; Günther, Albrecht; Alonso, A. Husilllos; Fuhrer, Hannah; Schönenberger, Silvia; Petersen, Martina; Kohle, Felix; Müller, Annekatrin; Gawlitza, Alexander; Gubarev, Waldemar; Holtkamp, Martin; Vorderwülbecke, Bernd J.; notfallmedizin, das IGNITE!-Forschungsnetzwerk der Deutschen Gesellschaft für Neurointensiv und

doi:10.1007/s10309-021-00444-x

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…Interestingly, the patient with the lowest calculated recurrence risk was among the failed withdrawal cases. Currently, active registries, such as the German IGNITE trial (Initiative of German NeuroIntensive Trial Engagement), will help build more precise models for acute-symptomatic seizures in the future [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Video-EEG-monitoring to guide antiseizure medication withdrawal

Dhaenens-Meyer,

Schriewer,

Weber

et al. 2023

Neurol. Res. Pract.

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Background Discontinuing anti-seizure medication (ASM) should be considered in persons with epilepsy with long-term seizure freedom. Clinicians should also pursue ASM withdrawal in persons with one-time seizures without increased recurrence risk and those with suspected non-epileptic events. However, ASM withdrawal is associated with the risk of recurring seizures. Monitored ASM withdrawal in an epilepsy monitoring unit (EMU) could help better evaluate the risk of seizure recurrence. Here, we investigate the practice of EMU-guided ASM withdrawal, assess its indications, and aim to determine positive and negative predictors for successful withdrawal. Methods We screened the medical records of all patients admitted to our EMU between November 1, 2019, and October 31, 2021, and included patients of at least 18 years admitted with the aim of permanent ASM withdrawal. We defined four groups of withdrawal indications: (1) long-term seizure freedom; (2) suspected non-epileptic events; (3) history of epileptic seizures but not fulfilling diagnostic criteria of epilepsy; and (4) seizure-freedom after epilepsy surgery. Successful withdrawal was defined according to the following criteria: no recoding of (sub)clinical seizure activity during VEM (groups 1, 2, and 3), patients did not meet the International League Against Epilepsy (ILAE) definition of epilepsy (groups 2 and 3) [14], and patients were discharged without ongoing ASM treatment (all groups). We also evaluated the prediction model by Lamberink et al. (LPM) for the risk of seizure recurrence in groups 1 and 3. Results 55/651 (8.6%) patients fulfilled the inclusion criteria. Withdrawal indications were distributed as follows; group 1: 2/55 (3.6%); group 2: 44/55 (80%); group 3: 9/55 (16,4%); group 4: 0/55. Overall, ASM withdrawal was successful in 90.9%. The sensitivity of the LPM for a 2-year 50% relapse risk threshold was 75%, the specificity 33.3%; for a 5-year relapse risk respectively 12.5% and 33.3%, suggesting that the model is not suitable for risk assessment in patients with one-time seizures or acute-symptomatic seizures, who constituted most of the evaluated patients. Conclusions Our study suggests that EMU-guided ASM withdrawal could be a helpful tool to support clinical decision-making and improve patient safety. Prospective, randomized trials should further evaluate this method in the future.

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Section: Discussionmentioning

confidence: 99%

Video-EEG-monitoring to guide antiseizure medication withdrawal

Dhaenens-Meyer,

Schriewer,

Weber

et al. 2023

Neurol. Res. Pract.

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“…The PROSE register is an investigator-initiated, prospective, open, single-arm, observational study with ongoing follow-up for up to 3 years [ 17 ]. It is conducted as a multicenter study within the ‘Initiative of German Neuro-Intensive Trial Engagement’ (IGNITE!)…”

Section: Methodsmentioning

confidence: 99%

Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study

Herzig-Nichtweiß,

Salih,

Berning

et al. 2023

Ann. Intensive Care

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Background Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%. Methods Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey. Results Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%–16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8–69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0–9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate. Conclusions Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.

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