Incidence and mortality of super-refractory status epilepticus in adults

Kantanen, Anne-Mari; Reinikainen, Matti; Parviainen, Ilkka; Ruokonen, Esko; Ala-Peijari, Marika; Bäcklund, Tom; Koskenkari, Juha; Laitio, Ruut; Kälviäinen, Reetta

doi:10.1016/j.yebeh.2015.04.065

Cited by 106 publications

(88 citation statements)

References 15 publications

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“…The incidence of RSE in our population-based cohort was 3.4/100,000/year, and the incidence SRSE in our cohort was 0.7/100,000/year [16], constituting 22% of the patients with RSE. Depending on the definition of RSE that was used, 4–26% of patients with RSE have previously been reported to develop SRSE [21].…”

Section: Discussionmentioning

confidence: 99%

“…Our study group has recently reported on the incidence of SRSE and the mortality rates in patients with SRSE from this same patient cohort [16]. The aim of the present study was to determine predictors of hospital and 1-year mortality in ICU-treated patients with RSE, including patients evolving to SRSE, in a nationwide population-based study.…”

Section: Introductionmentioning

confidence: 94%

“…Moreover, there are both national and international guidelines and algorithms for better treatment of SE [2, 9–13]; however, the outcomes remain poor: Short-term mortality in adult SE and RSE vary in the range of 19–39% [6, 14], while longer-term mortality is in the range of 35–43% [4, 15]. Long-term mortality in SRSE is twofold higher than in RSE alone [16]. The mortality of SE is correlated with seizure duration, rapid identification of SE and aetiology of disease [1].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: a population-based study

et al. 2017

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BackgroundThe aim was to determine predictors of hospital and 1-year mortality in patients with intensive care unit (ICU)-treated refractory status epilepticus (RSE) in a population-based study.MethodsThis was a retrospective study of the Finnish Intensive Care Consortium (FICC) database of adult patients (16 years of age or older) with ICU-treated RSE in Finland during a 3-year period (2010–2012). The database consists of admissions to all 20 Finnish hospitals treating RSE in the ICU. All five university hospitals and 11 out of 15 central hospitals participated in the present study. The total adult referral population in the study hospitals was 3.92 million, representing 91% of the adult population of Finland. Patients whose condition had a post-anoxic aetiological basis were excluded.ResultsWe identified 395 patients with ICU-treated RSE, corresponding to an annual incidence of 3.4/100,000 (95% confidence interval (CI) 3.04–3.71). Hospital mortality was 7.4% (95% CI 0–16.9%), and 1-year mortality was 25.4% (95% CI 21.2–29.8%). Mortality at hospital discharge was associated with severity of organ dysfunction. Mortality at 1 year was associated with older age (adjusted odds ratio (aOR) 1.033, 95% CI 1.104–1.051, p = 0.001), sequential organ failure assessment (SOFA) score (aOR 1.156, CI 1.051–1.271, p = 0.003), super-refractory status epilepticus (SRSE) (aOR 2.215, 95% CI 1.20–3.84, p = 0.010) and dependence in activities of daily living (ADL) (aOR 2.553, 95% CI 1.537–4.243, p < 0.0001).ConclusionsDespite low hospital mortality, 25% of ICU-treated RSE patients die within a year. Super-refractoriness, dependence in ADL functions, severity of organ dysfunction at ICU admission and older age predict long-term mortality.Trial registrationRetrospective registry study; no interventions on human participants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: a population-based study

et al. 2017

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“…In one study, mortality 30 days after the onset of SE was 31% in the university hospital population and 27% in the community setting. 10 Although the cause of SE is an important factor in mortality, the aging brain itself may contribute to an unfavorable outcome. A population-based study found that overall mortality was 13% in young adults, increased to 38% in the 60-79 age group, and was up to 50% in those 80 years or older.…”

Section: Mortalitymentioning

confidence: 99%

Status epilepticus in the elderly

Leppik

2018

Epilepsia

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Children and the elderly (≥60 years of age) have the highest incidence of status epilepticus (SE). Because of their general health, elderly individuals are much more likely than younger (<60 years of age) persons to have more severe consequences from seizures. The incidence of SE is 15.5/100 000 in the 60-69 age group, 21.5/100 000 in the 70-79 age group and 25.9/100 000 in persons 80 and older. The most common cause in the elderly is acute symptomatic, with stroke and hypoxia the most frequent. The overall mortality of SE is quite high and occurs early, often within the first few days, and is related to the cause, with mortality of more than 80% in persons with anoxia. Although the cause of SE is an important factor in mortality, the aging body and brain may contribute to an unfavorable outcome. Treatment in the elderly is essentially the same as in younger adults with benzodiazepines (lorazepam, diazepam, clonazepam) and longer acting antiseizure drugs (phenytoin, fosphenytoin, valproate, levetiracetam, and lacosamide. At this time there are no evidence-based studies regarding Axis 2 (etiology) and Axis 4 (age). All current interventions for SE involve antiseizure drugs that were developed for treatment of chronic epilepsy. Treatments should be developed that are more specific for the various etiologies and involve drugs that work on the underlying cause of the SE.

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“…As morbidity and mortality increase with duration of SE, 10,11 fast and aggressive treatment is necessary. Beyond time point t2, defined as 30 minutes for generalized tonicclonic SE and 60 minutes for focal SE with impaired consciousness, 5 neuronal loss and neurotoxicity must be expected.…”

Section: Introductionmentioning

confidence: 99%

Perampanel in patients with refractory and super‐refractory status epilepticus in a neurological intensive care unit: A single‐center audit of 30 patients

et al. 2018

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In refractory status epilepticus (SE), γ-aminobutyric acidergic drugs become less effective and glutamate plays a major role in seizure perpetuation. Data on the efficacy of perampanel (PER) in treatment of refractory SE in humans are limited. Here, we present a single-center case series of patients with refractory SE who received PER orally in an intensive care unit. We retrospectively analyzed treatment response, outcome, and adverse effects of all patients with refractory SE in our Neurological Intensive Care Unit who received add-on PER between September 2012 and February 2018. Thirty patients with refractory SE (median = 72 years, range = 18-91, 77% women) were included. In 14 patients (47%), a high-dose approach was used, with a median initial dose of 24 mg (range = 16-32). In five patients (17%), SE could be terminated after PER administration (median dose = 6 mg, range = 6-20 mg, 2/5 patients in high-dose group). Clinical response was observed after a median of 24 hours (range = 8-48 hours), whereas electroencephalogram resolved after a median of 60 hours (range = 12-72 hours). Time to treatment response tended to be shorter in patients receiving high-dose PER (median clinical response = 16 hours vs 18 hours; electroencephalographic response = 24 hours vs 72 hours), but groups were too small for statistical analysis. Continuous cardiorespiratory monitoring showed no changes in cardiorespiratory function after "standard" and "high-dose" treatment. Elevated liver enzymes without clinical symptoms were observed after a median of 6 days in seven of 30 patients (23%; 57% high dose vs 43% standard dose), of whom six also received treatment with phenytoin (PHT). Outcome was unfavorable (death, persistent vegetative state) in 13 patients (43%; 39% high dose vs 61% standard dose), and good recovery (no significant disability, moderate disability) was achieved in nine patients (56% high dose vs 44% standard dose). Oral PER in loading doses up to 32 mg were well tolerated but could terminate SE only in a few patients (5/30; 17%). Long duration of SE, route of administration, and severe underlying brain dysfunction might be responsible for the modest result. An intravenous formulation is highly desired to explore the full clinical utility in the treatment of refractory SE.

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Incidence and mortality of super-refractory status epilepticus in adults

Cited by 106 publications

References 15 publications

Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: a population-based study

Predictors of hospital and one-year mortality in intensive care patients with refractory status epilepticus: a population-based study

Status epilepticus in the elderly

Perampanel in patients with refractory and super‐refractory status epilepticus in a neurological intensive care unit: A single‐center audit of 30 patients

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