serval:BIB_36D08836A6EF
Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents.
10.1007/s40263-017-0424-1
000398994900007
28337727
Beuchat
I.
author
Novy
J.
author
Rossetti
A.O.
author
article
2017-04
CNS drugs
1179-1934
1172-7047
journal
31
4
327-334
Newer antiepileptic drugs (AEDs) are increasingly prescribed; however, relatively limited data are available regarding their use in status epilepticus (SE) and the impact on outcome.
The aim of this study was to explore the evolution in prescription patterns of newer and traditional AEDs in this clinical setting, and their association with prognosis.
We analyzed our prospective adult SE registry over a 10-year period (2007-2016) and assessed the yearly use of newer and traditional AEDs and their association with mortality, return to baseline conditions at discharge, and SE refractoriness, defined as treatment resistance to two AEDs, including benzodiazepines.
In 884 SE episodes, corresponding to 719 patients, the prescription of at least one newer AED increased from 0.38 per SE episode in 2007 to 1.24 per SE episode in 2016 (mostly due to the introduction of levetiracetam and lacosamide). Traditional AEDs (excluding benzodiazepines) decreased over time from 0.74 in 2007 to 0.41 in 2016, correlating with the decreasing use of phenytoin. The prescription of newer AEDs was independently associated with a lower chance of return to baseline conditions at discharge (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.40-0.84) and a higher rate of SE refractoriness (OR 19.84, 95% CI 12.76-30.84), but not with changes in mortality (OR 1.08, 95% CI 0.58-2.00).
We observed a growing trend in the prescription of newer AEDs in SE over the last decade; however, our findings might suggest an associated increased risk of SE refractoriness and new disability at hospital discharge. Pending prospective, comparative studies, this may justify some caution in the routine use of newer AEDs in SE.
Adult
Aged
Aged, 80 and over
Anticonvulsants/therapeutic use
Cohort Studies
Female
Humans
Male
Middle Aged
Practice Patterns, Physicians'/trends
Prognosis
Registries
Retrospective Studies
Status Epilepticus/drug therapy
Status Epilepticus/physiopathology
Treatment Outcome
eng
60_published
true
peer-reviewed
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
University of Lausanne
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