Christoph Kellinghaus1,2, Andrea O Rossetti3, Eugen Trinka4,5, Nicolas Lang6, Theodor W May7, Iris Unterberger8, Stephan Rüegg9, Raoul Sutter10, Adam Strzelczyk11,12, Christian Tilz13, Zeljko Uzelac14, Felix Rosenow11,12. 1. Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany. 2. Epilepsy Center Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany. 3. Department of Clinical Neurosciences, CHUV and University of Lausanne, Lausanne, Switzerland. 4. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria. 5. Centre for Cognitive Neuroscience Salzburg, Salzburg, Austria. 6. Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. 7. Society for Epilepsy Research, Bielefeld, Germany. 8. Department of Neurology, Innsbruck Medical University, Innsbruck, Austria. 9. Department of Neurology, University Hospital Basel, Basel, Switzerland. 10. Medical Intensive Care Units and Department of Neurology, University Hospital Basel, Basel, Switzerland. 11. Epilepsy Center Hessen-Marburg, Department of Neurology, University Hospitals and Philipps-University Marburg, Marburg, Germany. 12. Epilepsy Center Frankfurt Rhein-Main, Department of Neurology, University Hospital Frankfurt and Goethe University, Frankfurt, Germany. 13. Department of Neurology, Krankenhaus Barmherzige Brüder, Regensburg, Germany. 14. Department of Neurology, University Hospital Ulm, Ulm, Germany.
Abstract
OBJECTIVE: To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables. METHODS: 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. RESULTS: 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. INTERPRETATION: 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.
OBJECTIVE: To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables. METHODS: 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. RESULTS: 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. INTERPRETATION: 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.
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