Outcome of status epilepticus and the predictive value of the EMSE and STESS scores: A prospective study

Sairanen, Joni J.; Kantanen, Anne-Mari; Hyppölä, Harri; Kälviäinen, Reetta

doi:10.1016/j.seizure.2019.12.026

Cited by 10 publications

(11 citation statements)

References 21 publications

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“…A recent study reported an incidence of ASz of 15.2% and an incidence of status epilepticus of 1.9% among cSDH patients, and seizures were associated with unfavorable outcomes. Several other studies have reported similar results regarding associations between seizures and high morbidity and mortality rates [6,8,11,21]. In the current study, the incidence of ASz and status epilepticus in acSDH were approximately five times higher than those for the normal cSDH population; therefore, we believe that prophylactic treatment with AEDs should be considered for acSDH cases.…”

Section: Discussionsupporting

confidence: 83%

Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

Won

Dubinski

Freiman

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Acute-on-chronic subdural hematoma (acSDH) describes acute bleeding into a chronic subdural hematoma (SDH), after surgery or second trauma. Because seizures are a well-known complication of SDH, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures (ASz), including status epilepticus, and determine the functional outcomes in this specific cohort of patients. Methods A retrospective analysis was performed, including patients with acSDH who were admitted to our department between 2010 and 2019. The incidence and timely onset of ASz and status epilepticus were evaluated. Functional outcomes at discharge and at 3–6 month follow-up were analyzed based on the modified Rankin scale. Results Of 506 patients with chronic SDH, 29 patients (5.7%) were diagnosed with acSDH. The overall incidence of ASz and status epilepticus were 72.4% and 10.3%, respectively. Favorable outcomes were identified in 11 patients (52.4%) in the ASz group compared with 6 patients (75%) in the non-ASz group. The mortality rate was higher in the ASz group compared with that in the control group (29% vs 0%). At follow-up, favorable outcomes were similar to those observed at discharge (52.4% in the ASz group and 71.4% in the control group). The mortality rate was still higher in the ASz group, at 32% compared with 14% for the control group. Conclusion AcSDH has a high risk for ASz, including status epilepticus, and is associated with unfavorable outcomes and high mortality. Thus, prophylactic treatment with antiepileptic drugs should be considered among this specific cohort of patients.

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Section: Discussionsupporting

confidence: 83%

Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

Won

Dubinski

Freiman

et al. 2020

Eur J Trauma Emerg Surg

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“…All of them are already known poor prognostic factors, not modifiable ones, so its relevance is lower than timing 2,8,38,39 . STESS, a score developed for predicting SE prognosis at first clinical assessment before treatment initiation, was associated with increased morbimortality, replicating its prior results 40,41 . Additionally, STESS was related to the length of the SE, which may broaden its applicability.…”

Section: Discussionmentioning

confidence: 83%

“…2,8,38,39 STESS, a score developed for predicting SE prognosis at first clinical assessment before treatment initiation, was associated with increased morbimortality, replicating its prior results. 40,41 Additionally, STESS was related to the length of the SE, which may broaden its applicability. The low rate of underdosing of ASM and its lack of prognostic involvement might be due to the implementation of an urgent neurological care algorithm in our hospital, which includes prompt performance of EEG recordings and SE therapy protocol.…”

Section: Discussionmentioning

confidence: 99%

Therapy delay in status epilepticus extends its duration and worsens its prognosis

et al. 2020

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Background Timing in status epilepticus (SE) attention is probably the most relevant modifiable prognostic factor and may influence SE duration and prognosis. We aimed to describe the precise relationship between management timing, duration, and prognosis of SE. Methods Observational longitudinal prospective study on a cohort of all patients diagnosed with SE admitted to our tertiary hospital from September 2017 to August 2019, with a 3‐month follow‐up. Univariate and multivariable analyses were performed to identify clinical and timing variables associated with SE duration and prognosis. Results Eighty‐three SE affecting 76 patients were included. Median age was 73 years, 61.4% were women, median baseline modified Rankin Scale (mRS) was 2, and 55.4% had prior epilepsy. In the out‐of‐hospital group (n = 50), median time to emergencies was 1.3 h and to hospital admission 2.8 h. In the global series, median time to neurologist was 4.3 h, and median time to therapy initiation was 4.5 h. These four times positively correlated with SE duration (all Spearman's rho coefficient >0.5, all p < .001). SE median duration was 24 h and was extended 1.2 h for each hour of treatment delay. A longer SE duration was associated with increased mortality and morbidity, both at hospital discharge and at 3‐month follow‐up (both p < .05). After 3 months, mortality was 30.1%, while recovery to baseline mRS occurred in 39.5%, with an overall median mRS of 4. Conclusions There were pervasive delays in all phases of SE attention, which conditioned a longer SE duration, and this led to increased long‐term morbimortality.

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“…Our main objective was to identify and tackle the obstacles to optimal SE treatment, based on prospective observation of a real-life patient cohort. A secondary objective was to study the few RSE patients who could not be given intensive care but were assigned to palliative care insteada subgroup of patients that we identified in our earlier study on the outcomes of SE [16].…”

Section: Aim Of Studymentioning

confidence: 99%

“…In recurrent tonic-clonic seizures, by our operational definition, the onset of third seizure marked the beginning of SE. The data on treatment delay and outcomes in this cohort have been published previously [10,16].…”

Section: Data Collection and Analysismentioning

confidence: 99%

Status epilepticus: Practice variation and adherence to treatment guideline in a large community hospital

Sairanen

Kantanen

Hyppölä

et al. 2021

Journal of the Neurological Sciences

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To evaluate the treatment of status epilepticus (SE) and adherence to treatment guideline in a large Finnish community hospital. Materials and methods: A consecutive series of 137 patients treated in the emergency department of Kuopio University Hospital. Enrollment took place between March 23 and December 31, 2015. Pediatric patients and postanoxic seizures were excluded. The Finnish Status Epilepticus Current Care Guideline was used as the evaluation benchmark. Results: Seventeen patients recovered spontaneously. First-line treatment was given to 108 patients with 35.2% efficacy. Second-line treatment was given to 81 patients with 87.7% efficacy. Six patients with refractory SE received successful third-line treatment and four were excluded from intensive care because of futility. The starting dose of a first-line drug was lower than the lowest therapeutic dose in 37.0% of the patients. The escalation from first-to second-line treatment took longer than 60 min in 55.1% of the 70 patients who received both treatments. The first loading dose of a second-line drug was markedly low (<80% of the recommended dose) in 26.2% of the 81 patients treated with second-line drugs. Conclusions: Prompt and effective pharmacotherapy is the cornerstone of good SE treatment. Subtherapeutic doses of first-line benzodiazepines should be avoided. Benzodiazepine-resistant SE must be recognized early to facilitate rapid treatment escalation. The quality of second-line treatment suffers from excessive delays and inadequate weight-based dosing of antiseizure medications.

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Outcome of status epilepticus and the predictive value of the EMSE and STESS scores: A prospective study

Cited by 10 publications

References 21 publications

Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

Therapy delay in status epilepticus extends its duration and worsens its prognosis

Status epilepticus: Practice variation and adherence to treatment guideline in a large community hospital

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