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

Fatuzzo, Daniela; Nový, Jan; Rossetti, Andrea O.

doi:10.1111/epi.14434

Cited by 17 publications

(17 citation statements)

References 18 publications

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“…The single‐center observational design limits the generalizability of this study. However, the similarity of the clinical characteristics in our population to those in other SE studies including age, outcome, etiologies, SE severity, and types of SE, indicates that our cohort has several characteristics typical of other large SE cohorts. Another limitation may be the approximation and therefore potential underestimation of SE duration, especially with unwitnessed onset, mainly the case with nonconvulsive SE .…”

Section: Discussionsupporting

confidence: 58%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery. Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated. Results: Of 467 patients, the median age was 66.7 years and mortality was 12%.Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99). Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed.

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Section: Discussionsupporting

confidence: 58%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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“…Of course, it is impossible to directly compare our results with these studies, mainly because our analysis was—per definition—limited to SE episodes finally resolved by AEDs. However, a relevant issue is open by these results, especially relative to NCSE, that we think need to be evaluated by future studies . A speculative hypothesis to explain the high success rate of valproate in NCSE could be based on the pathophysiological mechanisms of nonconvulsive SE.…”

Section: Discussionmentioning

confidence: 93%

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

et al. 2020

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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

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“…The Established Status Epilepticus Treatment Trial (ESETT) [13] will help clarify this issue, but the results are still pending. Recent studies related the use of newer AEDs at some point during an SE episode to lower rates of successful seizure cessation and worse overall prognosis [12,14]. The aim of the present study was to examine the influence of new vs traditional AEDs when used as secondline therapy on course and outcome of SE.…”

Section: Introductionmentioning

confidence: 98%

Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus

Reindl

Sprügel

Sembill

et al. 2020

Seizure

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New antiepileptic drugs (AEDs) are increasingly applied in second-line therapy of status epilepticus (SE). In our study, we analyzed the impact of the choice of second-line AEDs on the course and prognosis of SE. Methods: This retrospective single-center study used data of an 8 year cohort of SE in adults from 2007 to 2014. Based on the year of market introduction with a cutoff at 1990, we classified AEDs as traditional or new. Prescription pattern associated differences in prognosis were measured through univariate and multivariable analysis of 3 endpoints: occurrence of refractory SE (RSE), functional outcome in survivors to discharge (good: mRS at discharge < 3 or identical to admission mRS; otherwise poor), and in-hospital mortality. Results: From 362 SE episodes during the study period, 222 episodes were included into the study, among those 150 episodes treated with new and 72 with traditional AEDs. Use of new AEDs increased during the study period. After adjustment for confounders, treatment with new AEDs was on the one hand associated with higher rate of RSE occurrence (OR 1.95, 95 % CI 1.05-3.62, p = 0.03), but, on the other hand, also with better functional outcome at discharge (OR 2.64, 95 % CI 1.16-6.00, p = 0.02), while it was not an independent predictor of inhospital mortality (OR 0.88, 95 % CI 0.33-2.33, p = 0.80). Conclusion: Our observation that new AEDs may be associated with a higher rate of RSE development and relatively better functional outcome when adjusted for the premorbid mRS needs confirmation in prospective studies.

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

Cited by 17 publications

References 18 publications

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

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

Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus

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