Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents

Beuchat, Isabelle; Nový, Jan; Rossetti, Andrea O.

doi:10.1007/s40263-017-0424-1

Cited by 53 publications

(60 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Functional outcome appears to worsen across the analyzed time periods, as previously observed . It is unlikely that this reflects information bias following shorter acute stays, as hospitalization length was somewhat longer in 2017.…”

Section: Discussionsupporting

confidence: 66%

“…Our group already observed an increasing prescription of newer AEDs in SE, and a higher rate of failures in terminating SE using levetiracetam (LEV) rather than valproate as second‐line treatment, even if without impact on mortality . Moreover, a recent randomized double‐blind trial revealed no better efficacy on convulsive SE when adding LEV to clonazepam as first‐line prehospital treatment .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have highlighted a reduction of mortality in the past decade, hypothesizing that this could be a consequence of a prompter recognition of nonconvulsive SE and earlier, more aggressive, and more effective treatment . Conversely, other analyses have found a stable mortality rate and even an increasing number of patients with new morbidity at hospital discharge . Although this may also reflect higher prevalence of nonconvulsive SE, especially in comatose patients, it might be at least partly related to therapeutic strategies .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

2018

Self Cite

View full text Add to dashboard Cite

It is unclear whether the outcome of status epilepticus (SE), a neurological emergency associated with high mortality and morbidity, has changed over the past decade. We investigated the difference in prognosis (mortality, functional status at discharge) after adult SE episodes in a large registry between 2 time points (the years 2009 and 2017), exploring factors potentially associated with outcome, with particular attention to use of newer antiepileptic drugs (AEDs). Newer AEDs were more often prescribed in SE episodes in 2017 (80.2% vs 38.5%, P < .001); this independently correlated with year of observation, SE refractoriness, nonconvulsive SE forms, and number of AEDs. We observed a higher proportion of deterioration from baseline conditions in 2017 (67.7% vs 42.3%, P < .001), which was independently associated with, among other variables, use of newer AEDs (odds ratio = 2.91, 95% confidence interval = 1.13-7.48), whereas mortality seemed more stable over time (16.1% vs 6.3%, P = .08) without any relationship with newer AEDs. These observations suggest that newer AEDs might affect functional status but not mortality. Further investigations are necessary to improve therapeutic strategies, which currently rely on weak evidence.

show abstract

Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…BRV is a synaptic vesicle protein 2A (SV2A) ligand with greater affinity than levetiracetam for this target. It exceeds the binding potential of levetiracetam by 10‐ to 30‐fold . BRV was FDA approved in 2016 for partial‐onset seizures as monotherapy or adjunctive therapy with an initial recommended dose of 50 mg twice/day .…”

Section: Discussionmentioning

confidence: 99%

“…Despite these advantages, it is unclear whether newer AEDs are associated with better outcomes. In fact, some recent literature suggests newer agents may be associated with increased risk of SE refractoriness and new disability at hospital discharge . We therefore conducted a systematic review of the literature to identify evidence supporting the use of new AEDs in SE, RSE, and SRSE.…”

Section: Pk/pd Summary Of New Aedsmentioning

confidence: 99%

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

et al. 2020

View full text Add to dashboard Cite

Objective: To evaluate clinical outcomes and treatment effectiveness of status epilepticus finally resolved by nonbenzodiazepine antiepileptic drugs (AEDs). Methods: All consecutive SE episodes observed from September 1, 2013, to September 1, 2018, and resolved by AEDs were considered. Diagnosis and classification of SE followed the 2015 ILAE proposal. Nonconvulsive status (NCSE) diagnosis was confirmed according to the Salzburg EEG criteria. The modified Rankin Scale and deaths at 30 days from onset were used to evaluate outcomes. Results: A total of 277 status episodes (mean age 71 years; 61% female) were treated and resolved by antiepileptic drugs after 382 treatment trials. 68% of the SE resolved after AED use as first/second treatment line, while subsequent trials with AEDs gave an additional 32% resolution. A return to baseline conditions was observed in 48% of the patients, while overall mortality was 19% without significant changes across the study years. Mortality was higher in NCSE than in convulsive SE (22.5% vs 12.9%; P < .05), while mortality did not differ in SE episodes resolved by a first/second AED trial (17.2%) versus SE resolved by successive treatment trials (18.9%). The resolution rate of intravenous AEDs was 82% for valproate, 77% for lacosamide, 71% for phenytoin, and 62% for levetiracetam. No significant differences were found in head-to-head comparison, but for the valproate-levetiracetam one that was related to NCSE episodes in which valproate resulted to be effective in 86% of the trials while levetiracetam in 62% (P < .002). Significance: A high short-term mortality, stable over time, was observed in SE despite resolution of seizures, especially in SE with nonconvulsive semiology.Comparative AED efficacy showed no significant differences except for higher resolution rate for valproate versus levetiracetam in NCSE. K E Y W O R D Slacosamide, levetiracetam, mortality, outcomes, status epilepticus, valproate

show abstract

Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents

Abstract: Introduction

Cited by 53 publications

References 42 publications

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five‐year observational study

Contact Info

Product

Resources

About