Treatment and course of different subtypes of status epilepticus

Rantsch, K.; Walter, Uwe; Wittstock, Matthias; Rösche, Johannes

doi:10.1016/j.eplepsyres.2013.08.001

Cited by 34 publications

(33 citation statements)

References 33 publications

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“…30 A greater proportion of patients treated within an hour had generalized convulsive seizures compared to those treated outside of 1 hour (62 of 86 vs 54 of 139; p < 0.001), 36 and, similarly, patients presenting with convulsive seizures were more likely to receive treatment within an hour than patients with nonconvulsive seizures (125 of 254 vs 19 of 61; p < 0.001). 35 …”

Section: Resultsmentioning

confidence: 94%

Timing is everything: Where status epilepticus treatment fails

Hill

Parikh

Ellis

et al. 2017

Annals of Neurology

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Status epilepticus is an emergency; however, prompt treatment of patients with status epilepticus is challenging. Clinical trials, such as the ESETT (Established Status Epilepticus Treatment Trial), compare effectiveness of antiepileptic medications, and rigorous examination of effectiveness of care delivery is similarly warranted. We reviewed the medical literature on observed deviations from guidelines, clinical significance, and initiatives to improve timely treatment. We found pervasive, substantial gaps between recommended and “real-world” practice with regard to timing, dosing, and sequence of antiepileptic therapy. Applying quality improvement methodology at the institutional level can increase adherence to guidelines and may improve patient outcomes.

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Section: Resultsmentioning

confidence: 94%

Timing is everything: Where status epilepticus treatment fails

Hill

Parikh

Ellis

et al. 2017

Annals of Neurology

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“…CLZ was safe and effective in treating SE . More recently, a single‐center retrospective assessment of 167 SE episodes found that CLZ was the most effective first‐line therapy, with a success rate of 50%, as compared to 29% for LZP or 18% for diazepam . The favorable pharmacologic profile of CLZ, including its high lipophily and GABA a affinity, and its long half‐life may account for its efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…28 More recently, a single-center retrospective assessment of 167 SE episodes found that CLZ was the most effective first-line therapy, with a success rate of 50%, as compared to 29% for LZP or 18% for diazepam. 29 The favorable pharmacologic profile of CLZ, including its high lipophily and GABA a affinity, and its long halflife 13,14 may account for its efficacy. It may provide a longer duration of seizure control between the CLZ and the second-line drug by means of a synergistic effect on seizure cessation, and avoid seizure recurrence in the acute setting.…”

Section: Discussionmentioning

confidence: 99%

Practice variability and efficacy of clonazepam, lorazepam, and midazolam in status epilepticus: A multicenter comparison

et al. 2015

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Summary Objective Benzodiazepines (BZD) are recommended as first-line treatment for status epilepticus (SE), with lorazepam (LZP) and midazolam (MDZ) being the most widely used drugs and part of current treatment guidelines. Clonazepam (CLZ) is also utilized in many countries; however, there is no systematic comparison of these agents for treatment of SE to date. Methods We identified all patients treated with CLZ, LZP, or MDZ as a first-line agent from a prospectively collected observational cohort of adult patients treated for SE in four tertiary care centers. Relative efficacies of CLZ, LZP, and MDZ were compared by assessing the risk of developing refractory SE and the number of antiseizure drugs (ASDs) required to control SE. Results Among 177 patients, 72 patients (40.62%) received CLZ, 82 patients (46.33%) LZP, and 23 (12.99%) MDZ; groups were similar in demographics and SE characteristics. Loading dose was considered insufficient in the majority of cases for LZP, with a similar rate (84%, 95%, and 87.5%) in the centers involved, and CLZ was used as recommended in 52% of patients. After adjustment for relevant variables, LZP was associated with an increased risk of refractoriness as compared to CLZ (odds ratio [OR] 6.4, 95% confidence interval [CI] 2.66–15.5) and with an increased number of ASDs needed for SE control (OR 4.35, 95% CI 1.8–10.49). Significance CLZ seems to be an effective alternative to LZP and MDZ. LZP is frequently underdosed in this setting. These findings are highly relevant, since they may impact daily practice.

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“…Polytherapy used as initial therapy was not mentioned either in two SE management practice surveys based on hypothetical case (Claassen et al, 2003), (Riviello et al, 2013), but it is important to remind that the questions asked in the survey didn't evoke any combined therapy. Finally, the rate of success of first line therapy in observational studies is lower than reported in controlled trials (Aranda et al, 2010), (Alvarez et al, 2011), (Cook et al, 2012), (Rantsch et al, 2013), probably reflecting the common practice of a rapid second line treatment administration without waiting for first line failure to control the seizures.…”

Section: Clinical Practicementioning

confidence: 70%