Treatment deviating from guidelines does not influence status epilepticus prognosis.

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Serval ID
serval:BIB_F53FF881FF6B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Treatment deviating from guidelines does not influence status epilepticus prognosis.
Journal
Journal of Neurology
Author(s)
Rossetti A.O., Alvarez V., Januel J.M., Burnand B.
ISSN
1432-1459 (Electronic)
ISSN-L
0340-5354
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
260
Number
2
Pages
421-428
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish. PDF type: Original communication
Abstract
Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (± 30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3-82.8] and SE severity (STESS ≥ 3; OR 1.7, 95 % CI 1.2-2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9-14.0) and STESS ≥ 3 (OR 1.7, 95 % CI 1.4-2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches.
Pubmed
Web of science
Open Access
Yes
Create date
18/02/2013 12:35
Last modification date
01/10/2019 7:20
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