Refractory Status Epilepticus: Risk Factors and Analysis of Intubation in the Multicenter SENSE Registry.

Adult Humans Female Aged Male Retrospective Studies Cohort Studies Anticonvulsants / therapeutic use Status Epilepticus / therapy Risk Factors Registries Intubation, Intratracheal / adverse effects

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
18 10 2022
Historique:
received: 04 02 2022
accepted: 27 06 2022
pubmed: 11 8 2022
medline: 19 11 2022
entrez: 10 8 2022
Statut: ppublish

Résumé

Refractory status epilepticus (RSE) bears significant morbidity and mortality. Therapy escalation and in some cases intubation are recommended. Most existing studies are retrospective and focus on intensive care units. We aimed to describe routine-care management and analyze determinants of RSE development and outcomes in a large multicenter cohort. We performed post hoc analysis of an observational, cohort study, which prospectively registered all consecutive adults with SE at 9 centers from 3 central European countries. Only incident episodes were included. Ongoing SE despite 2 antiseizure medications was defined as RSE. Patients intubated during first-line or second-line treatments were excluded. Variables investigated included demographics, severity (Status Epilepticus Severity Score), etiology, and guideline-compliant treatment (defined as fixed minimum doses). Outcome parameters included survival and mRS at baseline, and discharge (good: 0-2, or absence of worsening compared with prehospitalization). Among 1,179 SE episodes from 1,049 adults, 996 patients were eligible (median age: 70 years, 52% female), of which 545 (54.7%) developed RSE. RSE was associated with higher baseline mRS ( Variables associated with RSE were identified, some potentially preventable. More than 70% of RSE were treated without intubation, suggesting that focal RSE without deep impairment of consciousness, in older patients, may be successfully treated outside ICUs. Original cohort study registered at the German Clinical Trials Register (DRKS00000725).

Sections du résumé

BACKGROUND AND OBJECTIVES
Refractory status epilepticus (RSE) bears significant morbidity and mortality. Therapy escalation and in some cases intubation are recommended. Most existing studies are retrospective and focus on intensive care units. We aimed to describe routine-care management and analyze determinants of RSE development and outcomes in a large multicenter cohort.
METHODS
We performed post hoc analysis of an observational, cohort study, which prospectively registered all consecutive adults with SE at 9 centers from 3 central European countries. Only incident episodes were included. Ongoing SE despite 2 antiseizure medications was defined as RSE. Patients intubated during first-line or second-line treatments were excluded. Variables investigated included demographics, severity (Status Epilepticus Severity Score), etiology, and guideline-compliant treatment (defined as fixed minimum doses). Outcome parameters included survival and mRS at baseline, and discharge (good: 0-2, or absence of worsening compared with prehospitalization).
RESULTS
Among 1,179 SE episodes from 1,049 adults, 996 patients were eligible (median age: 70 years, 52% female), of which 545 (54.7%) developed RSE. RSE was associated with higher baseline mRS (
DISCUSSION
Variables associated with RSE were identified, some potentially preventable. More than 70% of RSE were treated without intubation, suggesting that focal RSE without deep impairment of consciousness, in older patients, may be successfully treated outside ICUs.
TRIAL REGISTRATION INFORMATION
Original cohort study registered at the German Clinical Trials Register (DRKS00000725).

Identifiants

DOI: 10.1212/WNL.0000000000201099 PMID: 35948449
pubmed: 35948449
pii: WNL.0000000000201099
doi: 10.1212/WNL.0000000000201099
doi:

Substances chimiques

Anticonvulsants 0

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e1824-e1834

Informations de copyright

© 2022 American Academy of Neurology.

Auteurs

Isabelle Beuchat (I)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0002-9300-4443

Felix Rosenow (F)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0002-3989-7471

Christoph Kellinghaus (C)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0001-5491-2302

Eugen Trinka (E)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.

Iris Unterberger (I)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0001-6408-5777

Stephan Rüegg (S)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.

Raoul Sutter (R)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0002-6575-356X

Christian Tilz (C)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.

Zeljko Uzelac (Z)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0003-2479-2025

Andrea O Rossetti (AO)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany. andrea.rossetti@chuv.ch.
ORCID: 0000-0002-7878-172X

Adam Strzelczyk (A)

From the Epilepsy Center Frankfurt Rhine-Main (I.B., F.R., A.S.), LOEWE Center for Personalized Translational Epilepsy Research (CePTER) (I.B., F.R.), and Department of Neurology (I.B., F.R., A.S.), Goethe-University, Frankfurt am Main, Germany; Department of Neurology (I.B., A.O.R.), Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Department of Neurology (C.K.), Klinikum Osnabrück; Epilepsy Center (C.K.), Münster-Osnabrück, Campus Osnabrück, Osnabrück, Germany; Department of Neurology (E.T.) and Neuroscience Institute (E.T.), Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health (E.T.), Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology (E.T.), Salzburg; Department of Neurology (I.U.), Innsbruck Medical University, Innsbruck, Austria; Department of Neurology (S.R., R.S.) and Intensive Care Units (R.S.), University Hospital Basel, Basel, Switzerland; Department of Neurology (C.T.), Krankenhaus Barmherzige Brüder, Regensburg; Department of Neurology (Z.U.), University Hospital Ulm; and Epilepsy Center Hessen and Department of Neurology (A.S.), Philipps-University Marburg, Germany.
ORCID: 0000-0001-6288-9915

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Anticonvulsivants › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Crises épileptiques › État de mal épileptique › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Refractory Status Epilepticus: Risk Factors...
questionsmedicales.fr › Techniques d'investigation › Intubation › Intubation trachéale › Refractory Status Epilepticus: Risk Factors...