Pia De Stefano1, Sira Maria Baumann2, Saskia Semmlack3, Stephan Rüegg3,4, Stephan Marsch2,3, Margitta Seeck5, Raoul Sutter2,3,4,6. 1. EEG and Epilepsy Unit, Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva, Geneva, Switzerland pia.destefano@hcuge.ch. 2. Medical faculty, University of Basel, Basel, Switzerland. 3. Department of Intensive Care, University Hospital Basel, Basel, Switzerland. 4. Division of Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland. 5. EEG and Epilepsy Unit, Department of Clinical Neurosciences and Faculty of Medicine of Geneva, University Hospital of Geneva, Geneva, Switzerland. 6. Department of Clinical Research, University of Basel, Basel, Switzerland.
Abstract
OBJECTIVE: To explore safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs. METHODS: Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, ICU and hospital stay. RESULTS: Of 230 patients, 205 received treatment escalation after first-line medication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line non-anesthetic antiseizure drugs. Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and with an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration, ICU and hospital stay. CONCLUSIONS: Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE, ICU and hospital stays. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE, ICU and hospital stays compared to the use of a second-line non-anesthetic antiseizure drug instead or prior to anesthetics, without an associated increase in complications.
OBJECTIVE: To explore safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs. METHODS: Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, ICU and hospital stay. RESULTS: Of 230 patients, 205 received treatment escalation after first-line medication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line non-anesthetic antiseizure drugs. Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and with an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration, ICU and hospital stay. CONCLUSIONS: Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE, ICU and hospital stays. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE, ICU and hospital stays compared to the use of a second-line non-anesthetic antiseizure drug instead or prior to anesthetics, without an associated increase in complications.