Factors predicting cessation of status epilepticus in clinical practice: Data from a prospective observational registry (SENSE).

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Serval ID
serval:BIB_8C364B85CA61
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Factors predicting cessation of status epilepticus in clinical practice: Data from a prospective observational registry (SENSE).
Journal
Annals of neurology
Author(s)
Kellinghaus C., Rossetti A.O., Trinka E., Lang N., May T.W., Unterberger I., Rüegg S., Sutter R., Strzelczyk A., Tilz C., Uzelac Z., Rosenow F.
ISSN
1531-8249 (Electronic)
ISSN-L
0364-5134
Publication state
Published
Issued date
03/2019
Peer-reviewed
Oui
Volume
85
Number
3
Pages
421-432
Language
english
Notes
Publication types: Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables.
Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni- and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE [GCSE]) and 12 hours (for non-GCSE) of initiating treatment.
Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non-GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE and 73% in non-GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of GCSE patients and 78% of non-GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment and in 342 non-GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that use of benzodiazepines as first treatment step and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups.
In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This underdosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as a first treatment step. ANN NEUROL 2019;85:421-432.
Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Anticonvulsants/therapeutic use, Austria, Benzodiazepines/therapeutic use, Dose-Response Relationship, Drug, Female, Germany, Guideline Adherence, Humans, Levetiracetam/therapeutic use, Male, Middle Aged, Multivariate Analysis, Practice Guidelines as Topic, Prognosis, Proportional Hazards Models, Prospective Studies, Registries, Status Epilepticus/drug therapy, Switzerland, Time Factors, Treatment Outcome, Young Adult
Pubmed
Web of science
Create date
31/01/2019 17:21
Last modification date
23/01/2020 7:19
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