Summary Purpose:  Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE. Methods:  This is a prospective population‐based study of consecutive adults with GCSE in Haute‐Garonne district, France. Demographics and treatment procedures were documented. Factors associated with seizure termination and refractoriness were analyzed using logistic regression. Results:  One hundred eighteen episodes in 111 adults (mean age 55 years) between October 2006 and February 2008 were included. SE was convulsive in 101 episodes. Incidence was 6.6 per 100,000 and case fatality was 9%. Adequate initial treatment according to protocol was observed in 38%; 64% were treated out‐of‐hospital, and SE was refractory in 27% [no response after two antiepileptic drugs (AED)]. Patients who received adequate first‐line treatment were 6.8 times [95% confidence interval (CI) 2.8–16.9] more likely to have seizure termination, with 74% versus 29% efficacy rate (p < 0.0001). Inadequate initial management was 4.7 times (1.9–11.1) more likely to need several benzodiazepine doses (p = 0.0004) and 9.1 times (3.7–20) more likely to require a long‐acting AED as next treatment (p < 0.0001). Seizure termination after initial treatment was associated with decreased intensive care unit stay [1 (1–2) versus 2 (1–5.5) days, p < 0.0001] and hospital stay [3 (2–11) versus 7 (3–18) days, p = 0.009]. Discussion:  GCSE termination and outcome seem clearly associated with adherence to treatment protocol. Results add to the debate on appropriate allocation of resources for out‐of‐hospital treatment, licensed drugs, and achievement of guideline implementation to improve SE outcome.

The respiratory systems of the mother cells and forespores of Bacilus cereus were compared throughout the maturation stages (E to VI) of sporulation. The results indicated that both cell compartments contain the same assortment of oxidoreductases and cytochromes. However membrane fractions from young forespores were clearly distinct from those of the mother cell, i.e., lower content of cytochrome aa3, lower cytochrome c oxidase activity, higher concentration of cytochrome o, and a lower sensitivity of the respiration to the inhibiting effect of cyanide. This suggests that the cyanide-resistant pathway contributes more importantly to forespore respiratory activity than to activity in the mother cell compartment. During the maturation stages, the forespore NADH oxidase activity declined faster than in the mother cells. Other activities studied decreased steadily in both cell compartments. These findings together with the analysis of the kinetics of NADHdependent reduction of cytochromes in the mature spore membranes indicated an impairment of electron flow between NADH dehydrogenase and cytochrome b. This impairment could be overcome by the addition of menadione.The sporulating cell of Bacillus species contains two distinct compartments: mother cell and forespore. The biochemical analysis of the separate entities has been made possible by the development of adequate forespore release techniques (1, 6). The evidence accumulated indicated that even very early in its development some of the biochemical properties of the forespore differ distinctly from those of mother cell (for a review, see reference 17). Early work on isolated young forespores suggested the presence of a membrane-bound respiratory system with a capacity to oxidize endogenous substrates and added NADH (2,5,8,24). Further investigations on Bacillus megaterium revealed quantitative differences in the assortment of cytochromes and in the levels of the respiratory activities of mother cell and forespore (10). In contrast to the developing forespore, the dormant spore is devoid of significant endogenous respiration (13, 21); apparently this is not merely due to the depletion of endogenous substrates, since the membrane particles of dormant spores are poorly active in the oxidation of NADH (25). These data suggest that the forespore respiratory system is inactivated during the finals steps of morphogenesis.The present work deals with the characterization of the respiratory systems of mother cells and forespores of Bacillus cereus and their regulation during maturation stages. In addition the composition and activity of the electron transport system of young forespores and dormant spores were compared. The results indicate that the respiratory system of the forespore differs from that of the mother cell in several respects. Furthermore the inactivation observed in the forespore respiratory system does not occur in the mother cell compartment, and the electron flow in the mature spore is impaired between NADH dehydrogenase and cytochrome b (cyt b). The impa...

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