Associations Between Time to Administration of Antiseizure Medications and Short-Term Clinical Outcomes in Adults With Status Epilepticus

Pongsakorn Kongsakorn; Apisit Boongird

doi:10.33165/rmj.2024.47.3.267564

Authors

Pongsakorn Kongsakorn Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Apisit Boongird Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33165/rmj.2024.47.3.267564

Keywords:

Status epilepticus, Mortality, Antiseizure medications, mRS

Abstract

Background: Status epilepticus (SE) is a time-sensitive emergency that requires immediate treatment.

Objective: To analyze the associations between time to administration of antiseizure medications (ASM) and short-term clinical outcomes.

Methods: From January 1, 2014, to December 31, 2020, we performed a retrospective cohort study in adult patients who presented with SE. The primary objective was to analyze the association between the timing of ASM administration and mortality. The second and third objectives were to determine the relationship between the timing of ASM administration and length of hospital stay along with the modified Rankin Scale (mRS) at discharge, respectively.

Results: A total of 83 patients were enrolled. The mean age was 57 years. The mean length of hospital stay was 32 days. Benzodiazepine (BDZ) was prescribed as the first ASM in 79 (95.2%) patients. Levetiracetam was the second most frequently administered ASM (39, [47%]), followed by phenytoin (28 [33.7%]) and valproate (13 [15.7%]). Seventy-one patients (85.5%) had a seizure duration longer than t₂ period. Therapy delay in SE and underdosing of ASM were noted in both alive and dead groups. Although the mortality rate was 20.5% and was highest in super-refractory SE (15 [88.2%]), we found no statistically significant difference between in-hospital mortality and timing of ASM administration. For secondary outcomes, including length of hospital stay and mRS, a statistically significant finding was only noted in the category of timing of seizure onset to the first ASM (P = .002 and P = .004, respectively).

Conclusions: This study showed no significant association between timing of ASM administration and in-hospital mortality. Prolonged duration of SE tends to be associated with increased mortality. SE guidelines were not followed in a substantial proportion of SE patients.

References

Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus—report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515-1523. doi:10.1111/epi.13121 DOI: https://doi.org/10.1111/epi.13121

Joshi S, Goodkin HP. The need to intervene before time point 2: evidence from clinical and animal data that status epilepticus damages the brain. J Clin Neurophysiol. 2020;37(5):375-380. doi:10.1097/WNP.0000000000000711 DOI: https://doi.org/10.1097/WNP.0000000000000711

Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: still more questions than answers. Lancet Neurol. 2011;10(10):922-930. doi:10.1016/S1474-4422(11)70187-9 DOI: https://doi.org/10.1016/S1474-4422(11)70187-9

Kantanen AM, Reinikainen M, Parviainen I, et al. Incidence and mortality of super-refractory status epilepticus in adults. Epilepsy Behav. 2015;49:131-134. doi:10.1016/j.yebeh.2015.04.065 DOI: https://doi.org/10.1016/j.yebeh.2015.04.065

Reznik ME, Berger K, Claassen J. Comparison of intravenous anesthetic agents for the treatment of refractory status epilepticus. J Clin Med. 2016;5(5):54. doi:10.3390/jcm5050054 DOI: https://doi.org/10.3390/jcm5050054

Gaínza-Lein M, Sánchez Fernández I, Jackson M, et al. Association of time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol. 2018;75(4):410-418. doi:10.1001/jamaneurol.2017.4382 DOI: https://doi.org/10.1001/jamaneurol.2017.4382

Gutiérrez-Viedma Á, Parejo-Carbonell B, Romeral-Jiménez M, et al. Therapy delay in status epilepticus extends its duration and worsens its prognosis. Acta Neurol Scand. 2021;143(3):281-289. doi:10.1111/ane.13363 DOI: https://doi.org/10.1111/ane.13363

Cheng JY. Latency to treatment of status epilepticus is associated with mortality and functional status. J Neurol Sci. 2016;370:290-295. doi:10.1016/j.jns.2016.10.004 DOI: https://doi.org/10.1016/j.jns.2016.10.004

Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American epilepsy society. Epilepsy Curr. 2016;16(1):48-61. doi:10.5698/1535-7597-16.1.48 DOI: https://doi.org/10.5698/1535-7597-16.1.48

Kellinghaus C, Rossetti AO, Trinka E, et al. SENSE registry for status epilepticus. Epilepsia. 2018;59(Suppl 2):150-154. doi:10.1111/epi.14495 DOI: https://doi.org/10.1111/epi.14495

Kapur J, Elm J, Chamberlain JM, et al. Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med. 2019;381(22):2103-2113. doi:10.1056/NEJMoa1905795 DOI: https://doi.org/10.1056/NEJMoa1905795