Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus. (January 2020)

• Record Type: Journal Article
• Authors: Reindl, Caroline; Sprügel, Maximilian I.; Sembill, Jochen A.; Mueller, Tamara M.; Hagen, Manuel; Gerner, Stefan T.; Kuramatsu, Joji B.; Hamer, Hajo M.; Huttner, Hagen B.; Madžar, Dominik
• Is Part Of: Seizure. Volume 74(2019)
• Page Start: 20
• Page End: 25
• Publication Date: 2020-01
• Subjects: Status epilepticus -- Established status epilepticus -- Anticonvulsant -- Treatment -- Refractoriness -- Functional outcome -- Mortality -- Antiepileptic drug; SE status epilepticus -- RSE refractory status epilepticus -- AED antiepileptic drug -- STESS Status Epilepticus Severity Score -- mRS modified Rankin Scale -- OR Odds Ratio -- CI confidence interval -- ICU intensive care unit; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2019.11.003
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Over the last decades, prescription pattern in second-line therapy of SE changed in favor of new AEDs. Despite being associated with higher rate of RSE occurrence, newer AEDs were related to better functional outcome. Application of new AEDs was not an independent predictor of mortality. Interpretation of our results is limited by missing data on exact dosing and timing of first- and second-line AED treatment. Abstract: Purpose: New antiepileptic drugs (AEDs) are increasingly applied in second-line therapy of status epilepticus (SE). In our study, we analyzed the impact of the choice of second-line AEDs on the course and prognosis of SE. Methods: This retrospective single- center study used data of an 8 year cohort of SE in adults from 2007 to 2014. Based on the year of market introduction with a cutoff at 1990, we classified AEDs as traditional or new. Prescription pattern associated differences in prognosis were measured through univariate and multivariable analysis of 3 endpoints: occurrence of refractory SE (RSE), functional outcome in survivors to discharge ( good : mRS at discharge <3 or identical to admission mRS; otherwise poor ), and in-hospital mortality. Results: From 362 SE episodes during the study period, 222 episodes were included into the study, among those 150 episodes treated with new and 72 with traditional AEDs. Use of new AEDs increased during the study period. After adjustment for confounders, treatment with new AEDs was on the one hand associated with higher rate of RSE occurrence (OR 1.95, 95 % CI 1.05–3.62, p = 0.03), but, on the other hand, also with better functional outcome at discharge (OR 2.64, 95 % CI 1.16–6.00, p = 0.02), while it was not an independent predictor of in- hospital mortality (OR 0.88, 95 % CI 0.33–2.33, p = 0.80). Conclusion: Our observation that new AEDs may be associated with a higher rate of RSE development and relatively better functional outcome when adjusted for the premorbid mRS needs confirmation in prospective studies.