Management of Status Epilepticus with Newer IV Anti-Seizure Agents in a Level Four Epilepsy Center
Abstract number :
2.199
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2017
Submission ID :
349494
Source :
www.aesnet.org
Presentation date :
12/3/2017 3:07:12 PM
Published date :
Nov 20, 2017, 11:02 AM
Authors :
Uma Menon, Ochsner Medical Center; Michael Pepper, Ochsner Medical Center; Anil Chimakurthy, Ochsner Medical Center; Alessandro Iliceto, Ochsner Medical Center; Sonesh Amin, Ochsner Medical Center; Neil Billeaud, Ochsner Medical Center; Fawad A. Khan, Och
Rationale: Management of status epilepticus (SE) in a level IV epilepsy center to assess outcomes with the use of newer IV anti-seizure agents (AEDs) Methods: Retrospective chart review of 360 patients with status epilepticus (SE) at Ochsner Neuro ICU during 2014-2016 was done with IRB approval. Diagnosis and resolution of SE was based on electroencephalography (EEG) reviewed by US board certified epileptologists. Results: Demographics were 148 males and 212 females; age range of 19 - 97 years306/360 (85%) had non-convulsive status epilepticus (NCSE) and 54/360 (15%) patients convulsive status epilepticus (CSE). In-hospital stay was 2 - 123 days (mean 21.2 days; median 16.8 days). Overall outcome was 252/360 (70%) survivors and 108 (30%) deaths. (Tables 1 a and 1b)Breakdown of 237 survivors (Tables 1a and 1b)Patients with withdrawal of care (WOC) (Tables 1a and 1b)NCSE resolved in 253/306 (82.7 %) and CSE resolved in all 53/54 (98.2%)Mortality in resolved NCSE was 52/253 (20.5%) with 33/52 (63 %) from withdrawal of care (WOC) and 19/52 (37 %) due to medical complications (Table 2)Mortality was 52/53 (98.1%) in unresolved NCSE, with 47/52 (90.4%) from WOC and 5/52 (9.6%) from medical complications (Table 2)IV AEDs used were Levetiracetam (310/360, 86.1 %), Lacosamide (209/360, 80.1 %) and Phenytoin (18/360, 5%). Other AEDs included Clobazam (106/360, 29.4 %), Valproate (60/360, 16.7 %), Vigabatrin (44/360; 12.2%) and Perampanel 26/360 (7%)Propofol and ketamine were used as single agents in 122/306 (39.9%, range 5-150 mkm) and 10/306 (3.3 %, range 5-200 mkm) respectively in NCSE. Both agents were used together in 81/306 (26.5%) in NCSE. Propofol was used as single agent in 17/54 (31.5%). Ketamine was not used singly for any patient with CSE. Both agents were used together for 4/54 (7.6%) Conclusions: In our cohort, overall survival was 70% (252/360) survivors and 30% (108/360) deaths with resolution of SE in 85% (306/360): NCSE in 83% (253/306) and CSE in 98.1% (53/54)Survival was associated with mean NICU stay of 22.7 (median 19.7) days in comparison to patients with WOC of mean 16.8 (median 14.8) days. SE was controlled in 41.5% (34/82) of patients who had WOC. Withdrawal of care was the most common cause of mortality unrelated to resolution of SE. Funding: None
Clinical Epilepsy