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Staged treatment response in status epilepticus: Lessons from the SENSE registry.
Beuchat, Isabelle; Novy, Jan; Rosenow, Felix; Kellinghaus, Christoph; Rüegg, Stephan; Tilz, Christian; Trinka, Eugen; Unterberger, Iris; Uzelac, Zeljko; Strzelczyk, Adam; Rossetti, Andrea O.
Afiliação
  • Beuchat I; Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
  • Novy J; Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
  • Rosenow F; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.
  • Kellinghaus C; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University, Frankfurt am Main, Germany.
  • Rüegg S; Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany.
  • Tilz C; Epilepsy Center, Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany.
  • Trinka E; Department of Neurology, University Hospital Basel, and University of Basel, Basel, Switzerland.
  • Unterberger I; Department of Neurology, Krankenhaus Barmherzige Brüder, Regensburg, Germany.
  • Uzelac Z; Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE, Salzburg, Austria.
  • Strzelczyk A; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg, Austria.
  • Rossetti AO; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
Epilepsia ; 65(2): 338-349, 2024 Feb.
Article em En | MEDLINE | ID: mdl-37914525
ABSTRACT

OBJECTIVES:

Although in epilepsy patients the likelihood of becoming seizure-free decreases substantially with each unsuccessful treatment, to our knowledge this has been poorly investigated in status epilepticus (SE). We aimed to evaluate the proportion of SE cessation and functional outcome after successive treatment steps.

METHODS:

We conducted a post hoc analysis of a prospective, observational, multicenter cohort (Sustained Effort Network for treatment of Status Epilepticus [SENSE]), in which 1049 incident adult SE episodes were prospectively recorded at nine European centers. We analyzed 996 SE episodes without coma induction before the third treatment step. Rates of SE cessation, mortality (in ongoing SE or after SE control), and favorable functional outcome (assessed with modified Rankin scale) were evaluated after each step.

RESULTS:

SE was treated successfully in 838 patients (84.1%), 147 (14.8%) had a fatal outcome (36% of them died while still in SE), and 11 patients were transferred to palliative care while still in SE. Patients were treated with a median of three treatment steps (range 1-13), with 540 (54.2%) receiving more than two steps (refractory SE [RSE]) and 95 (9.5%) more than five steps. SE was controlled after the first two steps in 45%, with an additional 21% treated after the third, and 14% after the fourth step. Likelihood of SE cessation (p < 0.001), survival (p = 0.003), and reaching good functional outcome (p < 0.001) decreased significantly between the first two treatment lines and the third, especially in patients not experiencing generalized convulsive SE, but remained relatively stable afterwards.

SIGNIFICANCE:

The significant worsening of SE prognosis after the second step clinically supports the concept of RSE. However, and differing from findings in human epilepsy, RSE remains treatable in about one third of patients, even after several failed treatment steps. Clinical judgment remains essential to determine the aggressiveness and duration of SE treatment, and to avoid premature treatment cessation in patients with SE.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Problema de saúde: 6_epilepsy Assunto principal: Estado Epiléptico / Epilepsia Limite: Adult / Humans Idioma: En Revista: Epilepsia Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Suíça

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Contexto em Saúde: 6_ODS3_enfermedades_notrasmisibles Problema de saúde: 6_epilepsy Assunto principal: Estado Epiléptico / Epilepsia Limite: Adult / Humans Idioma: En Revista: Epilepsia Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Suíça
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