Treatment of status epilepticus: a comparison of phenytoin, valproate, or levetiracetam

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Etat: Serval
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ID Serval
serval:BIB_5057288424F8
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
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Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Titre
Treatment of status epilepticus: a comparison of phenytoin, valproate, or levetiracetam
Titre de la conférence
21st Meeting of the European Neurological Society
Auteur(s)
Alvarez Vincent, Januel Jean-Marie, Burnand Burnand, Rossetti Andrea
Adresse
Lisbon, Portugal, May 28-31, 2011
ISBN
0340-5354
Statut éditorial
Publié
Date de publication
2011
Peer-reviewed
Oui
Volume
258
Série
Journal of Neurology
Pages
S53
Langue
anglais
Notes
Meeting Abstract - Oral session 21
Résumé
Objectives: Phenytoin (PHT), valproic acid (VPA), or levetiracetam (LEV) are commonly used as second-line treatment of status epilepticus (SE), but comparative studies are not available to date.Methods: In our tertiary care hospital, among 279 SE episodes prospectively collected over four years, and occurring in adults, we identified 187 episodes in which PHT, VPA or LEV were prescribed after benzodiazepines. Patients with post-anoxic SE were not included. Demographics, clinical SE features, failure of second-line treatment to control SE, new handicap and mortality at hospital discharge were assessed. Uni- and multivariable statistical analyses were applied to compare the three agents.Results: Each compound was used in about one third of episodes. VPA failed to control SE in 25.4%, PHT in 41.4% and LEV in 48.3% of episodes in which these were prescribed as second-line agents. After adjustment for known SE outcome predictors, LEV failed more often than VPA (OR 2.69; 95% CI 1.19-6.08); in others words, 16.8% (95% CI 6.0-31.4%) of second-line treatment failures could be attributed to prescription for LEV instead of VPA. PHT was statistically not different from the other two compounds. At discharge, second-line treatment did not influence new handicap and mortality, while etiology and severity of the SE episode were robust independent predictors.Conclusions: Even without significant differences on outcome at discharge, LEV seems less efficcacious than VPA to control SE after benzodiazepines. A prospective comparative trial is needed to address this potentially concerning finding. The second interesting finding is that the outcome seems more influenced by the SE characteristics than the treatment.
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Création de la notice
25/05/2011 13:20
Dernière modification de la notice
03/03/2018 17:08
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