Journal article
Latency to treatment of status epilepticus is associated with mortality and functional status
Journal of the neurological sciences, v 370, pp 290-295
15 Nov 2016
PMID: 27772779
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction: Status epilepticus (SE) is a life-threatening neurologic emergency. Despite advances in management, in-hospital mortality remains unchanged. This is partly due to the pharmacoresistance which develops the longer that seizures persist. Therefore, rapid antiseizure medication (ASM) administration may represent a beneficial treatment option. The purpose of this study was to determine: 1) whether in-hospital mortality is reduced with shorter latencies to initial treatment of SE with an ASM (LTSE); and 2) the critical time frame during which LTSE is associated with reduced in-hospital mortality.
Materials and methods: This was a retrospective, single-center study of adults diagnosed with SE between 1/1/2005 and 10/31/2012. Demographic characteristics included seizure history, etiology, semiology, and duration. Subjects were assigned to LTSE groups at the time frames of 5, 10, 30 and 60 min. The primary outcome was in-hospital mortality, with poor functional status (mRS 3-6) as a secondary measure. Pearson's chi-square, Mann-Whitney-U, two-sample-t-tests, and binary logistic regression analysis were used as appropriate, with p < 0.05.
Results: In unadjusted analysis, LTSE > 30 min demonstrated increased risk of mortality (OR 2.06, CI 1.01-4.17, p = 0.046) and poor functional status (OR 2.48, CI 1.05-5.85, p = 0.038) compared to LTSE 30 min. Increased mortality risk remained after adjusting for SE duration (OR 2.07, CI 1.01-4.26, p = 0.047) and nonconvulsive seizures (OR 228, CI 1.08-4.80, p = 0.03). Compared to subjects treated within 60 min, those treated after GO min were at increased risk of poor functional status, regardless of the presence of nonconvulsive seizures (OR 2.96, CI 1.14-7.73, p = 0.026). In addition, when acute symptomatic SE was stratified by cardiac versus non-cardiac etiologies, subjects with non-cardiac acute symptomatic SE demonstrated worse functional outcome when treated after 60 min (OR 7.20, CI 1.13-46.07, p = 0.037).
Conclusions: Treatment of SE within 30 min of onset is associated with reduced risk of in-hospital mortality and poor functional status, although this may be attenuated by acute symptomatic seizures related to cardiac arrest. This represents a therapeutic option which has the potential to benefit patient outcomes. (C) 2016 Elsevier B.V. All rights reserved.
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Details
- Title
- Latency to treatment of status epilepticus is associated with mortality and functional status
- Creators
- Jocelyn Y. Cheng - Supreme Council Of HealthWilliam Clement Regli
- Publication Details
- Journal of the neurological sciences, v 370, pp 290-295
- Publisher
- Elsevier
- Number of pages
- 6
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000387627800060
- Scopus ID
- 2-s2.0-84991248179
- Other Identifier
- 991019357632404721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Neurosciences