Document Detail


Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice.
MedLine Citation:
PMID:  20738380     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE.
METHODS: This is a prospective population-based study of consecutive adults with GCSE in Haute-Garonne district, France. Demographics and treatment procedures were documented. Factors associated with seizure termination and refractoriness were analyzed using logistic regression.
RESULTS: One hundred eighteen episodes in 111 adults (mean age 55 years) between October 2006 and February 2008 were included. SE was convulsive in 101 episodes. Incidence was 6.6 per 100,000 and case fatality was 9%. Adequate initial treatment according to protocol was observed in 38%; 64% were treated out-of-hospital, and SE was refractory in 27% [no response after two antiepileptic drugs (AED)]. Patients who received adequate first-line treatment were 6.8 times [95% confidence interval (CI) 2.8-16.9] more likely to have seizure termination, with 74% versus 29% efficacy rate (p < 0.0001). Inadequate initial management was 4.7 times (1.9-11.1) more likely to need several benzodiazepine doses (p = 0.0004) and 9.1 times (3.7-20) more likely to require a long-acting AED as next treatment (p < 0.0001). Seizure termination after initial treatment was associated with decreased intensive care unit stay [1 (1-2) versus 2 (1-5.5) days, p < 0.0001] and hospital stay [3 (2-11) versus 7 (3-18) days, p = 0.009].
DISCUSSION: GCSE termination and outcome seem clearly associated with adherence to treatment protocol. Results add to the debate on appropriate allocation of resources for out-of-hospital treatment, licensed drugs, and achievement of guideline implementation to improve SE outcome.
Authors:
Alexandre Aranda; Guillaume Foucart; Jean Louis Ducassé; Sabrina Grolleau; Aileen McGonigal; Luc Valton
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Epilepsia     Volume:  51     ISSN:  1528-1167     ISO Abbreviation:  Epilepsia     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2159-67     Citation Subset:  IM    
Copyright Information:
Wiley Periodicals, Inc. © 2010 International League Against Epilepsy.
Affiliation:
Service de Neurologie, Hôpital Rangueil, CHU Toulouse, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anticonvulsants / administration & dosage,  therapeutic use*
Clinical Protocols / standards
Cohort Studies
Drug Resistance
Emergency Service, Hospital / statistics & numerical data
France / epidemiology
Guideline Adherence
Health Services Research
Hospitalization / statistics & numerical data
Humans
Infusions, Intravenous
Intensive Care Units / statistics & numerical data
Length of Stay
Male
Middle Aged
Prospective Studies
Status Epilepticus / drug therapy*,  epidemiology
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticonvulsants

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