The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus

Abstract

GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h.

Status epilepticus alert reduces time to administration of second-line antiseizure medications

“…Because poor outcomes are associated with the duration of seizures, 3,5,6 time to administration of an adequately dosed ASM may have an important effect on morbidity and mortality. 3,7 In the present study, we hypothesized that the introduction of an SE alert system would reduce treatment delays compared to standard prior practice. Our SE alert was modeled after our existing stroke alert protocol.…”

“…3 In retrospective studies, late administration of a second-line ASM was associated with delayed return of consciousness and with poorer functional outcomes. 7,8 More rapid seizure control has the potential of decreasing these adverse outcomes.…”

The ADAN scale: a proposed scale for pre‐hospital use to identify status epilepticus

“…It is well recognized that prolonged duration of SE is an important factor related to prognosis. The time lapse from onset to diagnosis and treatment have been related to a poorer functional outcome in SE.…”

“…One of the main modifiable prognostic factors in SE is the duration of the episode , which is influenced by how quickly the various lines of treatment are applied (among other factors) . Depending on the type of SE, treatment should be initiated between 5 and 15 min after the onset of the episode ; hence, it is important to detect and treat patients with SE in the out‐of‐hospital setting .…”

Duration of therapeutic coma and outcome of refractory status epilepticus

“…Variables that were significant on bivariate analyses but included only a small percentage of the study cohort (such as the small number of patients treated with lacosamide as a second‐line therapy) or variables that were already included in other variables, were excluded (eg, age, preexisting comorbidities, RSE etiology, and pseudoperiodic epileptiform discharges (PEDs) on EEG monitoring, all of which are already included in the EMSE score; or age, previous history of epilepsy, presenting seizure type, and level of consciousness upon initial presentation, which are all part of the STESS). On the other hand, variables that showed only a marginal significance on bivariate analysis but have been shown to be associated with either the primary or one of the secondary outcomes in other clinical studies were included (eg, delayed initiation of treatment >1 hour after SE onset, which has been connected previously to worse seizure control and increased risk for breakthrough seizures). Other variables such as additional trials of TC, add‐on ASDs, or other treatment modalities utilized during the admission were not included in the multivariable analysis for the primary but secondary outcomes, which were obtained either at the end or over the course of the entire admission and not just the time frame of the initial TC itself.…”