Practice Variations in the Management of Status Epilepticus
Neurocritical Care , 05/18/2012
Cook AM et al. – The use of a benzodiazepine followed by an AED, such as phenytoin or levetiracetam, is common as first and second–line therapy for status epilepticus (SE) and appears to be associated with a shorter time to SE resolution. AED selection thereafter is highly variable. Patients without a history of seizure who develop SE had a higher mortality rate.Methods
- Fifteen American academic medical centers completed a retrospective, multicenter, observational study by reviewing 10–20 of the most recent cases of SE at their institution prior to December 31, 2009.
- A multivariate analysis was performed to determine factors associated with cessation of seizures.
- A total of 150 patients were included.
- Most patients with SE had a seizure disorder (58 %).
- SE patients required a median of 3 AEDs for treatment.
- Three quarters of patients received a benzodiazepine as first–line therapy (74.7 %).
- Phenytoin (33.3 %) and levetiracetam (10 %) were commonly used as the second AED.
- Continuous infusions of propofol, barbiturate, or benzodiazepine were used in 36 % of patients.
- Median time to resolution of SE was 1day and was positively associated with presence of a complex partial seizure, AED non–compliance prior to admission, and lorazepam plus another AED as initial therapy.
- Prolonged ICU length of stay and topiramate therapy prior to admission were negatively associated with SE resolution.
- Mortality was higher in patients without a history of seizure (22.2 vs 6.9 %, p=0.006).