Wolfgang G Muhlhofer1, Stephen Layfield2, Daniel Lowenstein3, Chee Paul Lin4, Robert D Johnson5, Shalini Saini6, Jerzy P Szaflarski1. 1. Department of Neurology/Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama. 2. Department of Neurology, Case Western Reserve University Hospitals, Cleveland, Ohio. 3. Department of Neurology, University of California San Francisco, San Francisco, California. 4. Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, Alabama. 5. Informatics Institute, Center for Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, Alabama. 6. Information Technology Department at School of Medicine Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
OBJECTIVE: Examine the association of duration of therapeutic coma (TC) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (RSE). Define an optimal window for TC that provides sustained seizure control and minimizes complications. METHODS: Retrospective, observational cohort study involving patients who presented with RSE to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of TC with primary and secondary outcomes was evaluated using two-sample t tests, simple linear regression, and chi-square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of TC for seizure recurrence was quantified using a receiver-operating characteristic curve. Youden index was used to determine an optimal cutoff value. RESULTS: Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of TC (27.2 vs 15.6 hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (P = 0.038) but not with poor functional neurologic outcome upon discharge, in-hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of TC were independently associated with fewer in-hospital complications (P = 0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of TC was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35 hours. SIGNIFICANCE: This study suggests that a shorter duration yet deeper TC as treatment for RSE may be more effective and safer than the currently recommended TC duration of 24-48 hours. Prospective and randomized trials should be conducted to validate these assertions. Wiley Periodicals, Inc.
OBJECTIVE: Examine the association of duration of therapeutic coma (TC) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (RSE). Define an optimal window for TC that provides sustained seizure control and minimizes complications. METHODS: Retrospective, observational cohort study involving patients who presented with RSE to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of TC with primary and secondary outcomes was evaluated using two-sample t tests, simple linear regression, and chi-square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of TC for seizure recurrence was quantified using a receiver-operating characteristic curve. Youden index was used to determine an optimal cutoff value. RESULTS: Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of TC (27.2 vs 15.6 hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (P = 0.038) but not with poor functional neurologic outcome upon discharge, in-hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of TC were independently associated with fewer in-hospital complications (P = 0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of TC was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35 hours. SIGNIFICANCE: This study suggests that a shorter duration yet deeper TC as treatment for RSE may be more effective and safer than the currently recommended TC duration of 24-48 hours. Prospective and randomized trials should be conducted to validate these assertions. Wiley Periodicals, Inc.
Authors: Ilkka Parviainen; Ari Uusaro; Reetta Kälviäinen; Esa Mervaala; Esko Ruokonen Journal: Intensive Care Med Date: 2006-05-06 Impact factor: 17.440
Authors: Andrea O Rossetti; Giancarlo Logroscino; Tracey A Milligan; Costas Michaelides; Christiane Ruffieux; Edward B Bromfield Journal: J Neurol Date: 2008-09-03 Impact factor: 4.849
Authors: Wei-Ting Chiu; Vanessa Campozano; Alois Schiefecker; Dannys Rivero Rodriguez; Daniel Ferreira; Amy Headlee; Sinead Zeidan; Alexandra Grinea; Yao-Hsien Huang; Kevin Doyle; Qi Shen; Diana Gómez; Sara E Hocker; Benjamin Rohaut; Romain Sonneville; Chien-Tai Hong; Sophie Demeret; Pedro Kurtz; Nelson Maldonado; Raimund Helbok; Telmo Fernandez; Jan Claassen Journal: Neurology Date: 2022-08-02 Impact factor: 11.800
Authors: David G Vossler; Jacquelyn L Bainbridge; Jane G Boggs; Edward J Novotny; Tobias Loddenkemper; Edward Faught; Marta Amengual-Gual; Sarah N Fischer; David S Gloss; Donald M Olson; Alan R Towne; Dean Naritoku; Timothy E Welty Journal: Epilepsy Curr Date: 2020-08-21 Impact factor: 7.500
Authors: Daniel B Rubin; Brigid Angelini; Maryum Shoukat; Catherine J Chu; Sahar F Zafar; M Brandon Westover; Sydney S Cash; Eric S Rosenthal Journal: Brain Date: 2020-04-01 Impact factor: 15.255
Authors: Matthew S Duprey; Mark van den Boogaard; Johannes G van der Hoeven; Peter Pickkers; Becky A Briesacher; Jane S Saczynski; John L Griffith; John W Devlin Journal: Crit Care Date: 2020-04-20 Impact factor: 9.097