Systemic complications of status epilepticus — An update

Hocker, Sara E.

doi:10.1016/j.yebeh.2015.04.024

Cited by 43 publications

(40 citation statements)

References 33 publications

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“…17 These scores take into consideration routine physiologic measurements regarding respiratory, cardiovascular, hepatic, coagulation, renal, neurologic, and electrolyte/acid-base balance systems. 18 Endotracheal intubation was used as a surrogate marker for respiratory failure, thus mechanical ventilation regardless of the reason is counted as a complication in respiratory system category. 18 Endotracheal intubation was used as a surrogate marker for respiratory failure, thus mechanical ventilation regardless of the reason is counted as a complication in respiratory system category.…”

Section: Cbi Definitionmentioning

confidence: 99%

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

et al. 2018

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Systemic complications are common in status epilepticus. We have no tools to evaluate total burden of complications and its effect on the outcome of status epilepticus. For Complication Burden Index (CBI) a patient is assessed for 13 complication categories: respiratory, cardiovascular, nervous, renal, hepatic, coagulation, gastrointestinal and musculoskeletal systems, electrolyte/acid-base balance, infection, hypo-/hyperglycemia, skin/allergic reactions, and mental condition. Maximum CBI is 13. CBI was internally validated in a retrospective cohort of 70 consecutive adult patients with generalized convulsive status epilepticus (GCSE) treated in a tertiary hospital over a period of 2 years. Functional outcome at discharge was defined Poor for Glascow Outcome Scale (GOS) 1-3 or worse-than-baseline condition and Good for GOS >3 or return to baseline condition. Relative risks (RRs) and receiver-operating characteristic (ROC) -curves were calculated to obtain optimal cutoff. Functional outcome was poor in 40% and worse-than-baseline in 59%. In-hospital mortality was 7%. Average CBI was 3.8 (range 0-10, median 3). Cutoff value predicting poor functional outcome was a CBI >3 (GOS 1-3 RR 1.84, P = .045, 95% confidence interval [CI 1.01-3.33; ROC-AUC [area under the curve] 0.687, P = .008, sensitivity 64%, specificity 61%; worse-than-baseline condition RR 1.52, P = .04, 95% CI 1.02-2.26; ROC-AUC 0.662, P = .022, sensitivity 56%, specificity 69%). CBI with cutoff >3 and as a continuous variable was associated with GOS1-3 (P = .046, P = .002) and with worse-than-baseline condition (P = .041, P = .004). CBI is a novel tool for comprehensive assessment of status epilepticus complications predicting poor/worse-than-baseline functional outcome with cutoff >3.

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Section: Cbi Definitionmentioning

confidence: 99%

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

et al. 2018

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“…However, this study was terminated before completing because of difficulties in patient enrolment and was therefore underpowered [89]. Recent retrospective cohorts suggest that administration of anesthetics may be associated with worsened outcome independently of possible confounders [90][91][92] or with systemic medical complications [93]. However, patients requiring treatment with anesthetics are those most severely ill, and this may also explain the higher mortality rates reported in some of these studies.…”

Section: Propofolmentioning

confidence: 99%

Recent advances in status epilepticus

Trinka

Brigo

Shorvon

2016

Current Opinion in Neurology

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“…Furthermore, anesthetics are very effective antiseizure drugs. 12 Propofol can cause the sometimes fatal propofol infusion syndrome (rapid development of metabolic acidosis, renal failure, and cardiovascular collapse), and therefore its use should be limited to doses < 5 mg/kg/h for no more than 3 days and avoided in younger patients. Conversely, anesthetic use has been consistently associated with longer hospital lengths of stay, death, and worse functional outcomes, [8][9][10] and evidence supporting their use is limited.…”

Section: Defining the Questionmentioning

confidence: 99%

“…Initiation of a CIVAD may avoid worsening pharmacoresistance to antiseizure drugs and limit both excitotoxic neuronal injury and systemic complications while allowing time for treatment targeting the cause of the seizures. 12 When using intravenous barbiturates, a number of serious adverse effects can be expected, including more pronounced cardiovascular depression and hypotension, paralytic ileus, anasarca, and an increased risk of pneumonia due to a reduction of ciliary function. All CIVADs cause respiratory depression, which must be managed with endotracheal intubation for airway protection and mechanical ventilation.…”

Section: Defining the Questionmentioning

confidence: 99%

“…[8][9][10]14,15,17 Convulsive SE leads to irreversible neuronal injury and serious systemic sequelae including primarily cardiopulmonary, renal, and musculoskeletal complications. 12 Uncontrolled NCSE increases the risk of a number of systemic complications, typically less severe than those associated with GCSE, but the impact on the brain is less clear. Studies evaluating the effects of NCSE in humans are difficult to interpret, as it can be difficult to parse out injury resulting from nonconvulsive seizures from damage arising as a result of the underlying cause of SE.…”

Section: Indications For Anesthesiamentioning

confidence: 99%

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Anesthetic drugs for the treatment of status epilepticus

Hocker

2018

Epilepsia

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Worsening pharmacoresistance to antiseizure drugs is common with ongoing excitotoxic neuronal and systemic injury. Early initiation of anesthetic drugs in refractory status epilepticus (RSE) may halt these processes while allowing time for treatment targeting the cause of the seizures. Current guidelines support the use of anesthetic drugs as the third line pharmacologic therapy in generalized convulsive status epilepticus but do not clearly define the indications for these drugs in other types of status epilepticus. There is wide practice variation in choice of third line therapy for RSE, but there is overall consensus that anesthetics should be initiated earlier in generalized convulsive status epilepticus than in nonconvulsive forms. More recently, doubt has been cast on the appropriateness of anesthetic treatment of RSE following a series of studies associating their use with higher mortality and morbidity. This suggests that efforts should focus on determination of who benefits most, optimal use, and prevention of refractoriness. The risk-benefit ratio of anesthetic use is discussed, with specific indications proposed. In addition, anesthetic dosing, supportive neurocritical care, electroencephalogram suppression target, and weaning of anesthesia are reviewed.

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Systemic complications of status epilepticus — An update

Cited by 43 publications

References 33 publications

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

Complication Burden Index—A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus

Recent advances in status epilepticus

Anesthetic drugs for the treatment of status epilepticus

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