The efficacy of different kinds of intravenously applied antiepileptic drugs in the treatment of status epilepticus. How can it be determined?

Redecker, Juliane; Wittstock, Matthias; Rösche, Johannes

doi:10.1016/j.yebeh.2017.03.018

Cited by 15 publications

(14 citation statements)

References 13 publications

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“…Firstly, our response definition represents a simplification of the complex factors determining SE cessation, and does not consider the potential effects of agents previously introduced. It represents however a pragmatic and objective endpoint from a clinical view (Redecker et al, 2017). Secondly, the retrospective design and relatively limited number of patients prevents drawing any firm conclusions: e.g.…”

Section: Discussionmentioning

confidence: 99%

Levetiracetam circulating concentrations and response in status epilepticus

Perrenoud

André

Buclin

et al. 2018

Epilepsy & Behavior

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Section: Discussionmentioning

confidence: 99%

Levetiracetam circulating concentrations and response in status epilepticus

Perrenoud

André

Buclin

et al. 2018

Epilepsy & Behavior

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“…There is also great need for standardization of efficacy criteria in studies of RSE/SRSE and efforts have been made to evaluate the influence of different efficacy criteria on the results of observational studies on treatment of SE [71]. Redecker et al found that "last drug introduced into the antiepileptic therapy or increased in dose within 24 h before termination of the SE without changes in the co-medication" was the most appropriate measure for the evaluation of efficacy of an AED in the treatment of SE and more reasonable than the "last antiepileptic drug (AED) administered before SE termination" [72]. Median latency from VNS implant to RSE/SRSE cessation was 8 days in this analysis and similar for KD, which is far beyond the frame of the former mentioned efficacy measure.…”

Section: Limitationsmentioning

confidence: 99%

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

et al. 2019

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Rationale: Refractory status epilepticus (RSE) is the persistence of status epilepticus despite second-line treatment. Super-refractory SE (SRSE) is characterized by ongoing status despite 48 h of anaesthetic treatment. Due to the high case fatality in RSE of 16e39%, off label treatments without strong evidence of efficacy in RSE are often administered. In single case-reports and small case series totalling 28 patients, acute implantation of VNS in RSE was associated with 76% and 26% success rate in generalized and focal RSE respectively. We performed an updated systematic review of the literature on efficacy of VNS in RSE/ SRSE by including all reported patients. Methods: We systematically searched EMBASE, CENTRAL, Opengre.eu, and ClinicalTrials.gov, and PubMed databases to identify studies reporting the use of VNS for RSE and/or SRSE. We also searched conference abstracts from AES and ILAE meetings. Results: 45 patients were identified in total of which 38 were acute implantations of VNS in RSE/SRSE. Five cases had VNS implantation for epilepsia partialis continua, one for refractory electrical status epilepticus in sleep and one for acute encephalitis with refractory repetitive focal seizures. Acute VNS implantation was associated with cessation of RSE/SRSE in 74% (28/38) of acute cases. Cessation did not occur in 18% (7/38) of cases and four deaths were reported (11%); all of them due to the underlying disease and unlikely related to VNS implantation. Median duration of the RSE/SRSE episode pre and post VNS implantation was 18 days (range: 3e1680 days) and 8 days (range: 3e84 days) respectively. Positive outcomes occurred in 82% (31/38) of cases. Conclusion: VNS can interrupt RSE and SRSE in 74% of patients; data originate from reported studies classified as level IV and the risk for reporting bias is high. Further prospective studies are warranted to investigate acute VNS in RSE and SRSE.

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“…Earlier administration was reported to confer improved efficacy as were higher doses, but neither of these strategies were compared directly with currently recommended therapies in a prospective manner or in a homogeneous cohort of SE patients. Most studies focused on efficacy based on termination of seizures, typically within 24 hours from the last drug administered …”

Section: Discussionmentioning

confidence: 99%

“…Most studies focused on efficacy based on termination of seizures, typically within 24 hours from the last drug administered. 63 Perampanel/PER (Fycompa) Perampanel was approved in 2012 for treatment of partial-onset seizures with or without secondary generalized seizures in patients with epilepsy as well as adjunctive therapy in the treatment of primary generalized tonic-clonic seizures in patients with epilepsy. It is currently available in tablet and oral suspension.…”

Section: Response After 30 Min Aes: None Reportedmentioning

confidence: 99%

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

et al. 2019

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Status epilepticus (SE) has a high mortality rate and is one of the most common neurologic emergencies. Fast progression of this neurologic emergency and lack of response to traditional antiepileptic drugs (AEDs) in most cases has challenged clinicians to use new agents. This article evaluates the efficacy and safety of AEDs released to the market after 2000 for SE, refractory status epilepticus (RSE), and super‐refractory status epilepticus (SRSE). The PubMed database was searched for clinical trials published between January 2000 and July 2018 using the search terms status epilepticus, refractory status epilepticus, super refractory status epilepticus, brivaracetam, clobazam, cannabidiol, eslicarbazepine, lacosamide, perampanel, rufinamide, stiripentol, and zonisamide. Trials that evaluated these agents in adults with SE, RSE, and SRSE were included. Brivaracetam use was identified in two retrospective reviews with success rates of 27% and 57%. One unsuccessful case report of cannabidiol use in SE was found. Four clobazam studies were identified in SE and RSE with success rates ranging from 25–100%. No evidence for the use of eslicarbazepine and zonisamide was found. Using the search terms for lacosamide identified 38 articles: 1 systematic review, 5 prospective studies, 15 retrospective reviews, and 17 case reports. Success rates and dosing varied, but studies that included focal or partial types of SE showed higher success rates. Five articles were identified regarding perampanel use in this setting. Three were retrospective reviews with success rates ranging from 17–60%, and two were case reports. Only one case report regarding the use of rufinamide was found; rufinamide titrated up to 4.4 mg/day allowed discontinuation of barbiturate and clobazam. One case report and two case series of stiripentol were found with reported efficacy between 60% and 100% in SRSE. Evidence is currently insufficient to support the use of these agents in this setting.

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The efficacy of different kinds of intravenously applied antiepileptic drugs in the treatment of status epilepticus. How can it be determined?

Cited by 15 publications

References 13 publications

Levetiracetam circulating concentrations and response in status epilepticus

Levetiracetam circulating concentrations and response in status epilepticus

Vagus nerve stimulation in refractory and super-refractory status epilepticus – A systematic review

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

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