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Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus

Baumann, Sira Maria
Semmlack, Saskia
Rüegg, Stephan
Marsch, Stephan
Sutter, Raoul
Published in Neurology. 2021, vol. 97, no. 6, p. e564-e576

Objective: To explore the safety and efficacy of artificial coma induction to treat status epilepticus (SE) immediately after first-line antiseizure treatment instead of following the recommended approach of first using second-line drugs.

Methods: Clinical and electrophysiologic data of all adult patients treated for SE from 2017 to 2018 in the Swiss academic medical care centers from Basel and Geneva were retrospectively assessed. Primary outcomes were return to premorbid neurologic function and in-hospital death. Secondary outcomes were the emergence of complications during SE, duration of SE, and intensive care unit (ICU) and hospital stays.

Results: Of 230 patients, 205 received treatment escalation after first-linemedication. Of those, 27.3% were directly treated with artificial coma and 72.7% with second-line nonanesthetic antiseizure drugs.Of the latter, 16.6% were subsequently put on artificial coma after failure of second-line treatment. Multivariable analyses revealed increasing odds for coma induction after first-line treatment with younger age, the presence of convulsions, and an increased SE severity as quantified by the Status Epilepticus Severity Score (STESS). While outcomes and complications did not differ compared to patients with treatment escalation according to the guidelines, coma induction after first-line treatment was associated with shorter SE duration and ICU and hospital stays.

Conclusions: Early induction of artificial coma is performed in more than every fourth patient and especially in younger patients presenting with convulsions and more severe SE. Our data demonstrate that this aggressive treatment escalation was not associated with an increase in complications but with shorter duration of SE and ICU and hospital stays. Classification of Evidence This study provides Class III evidence that early induction of artificial coma after unsuccessful first-line treatment for SE is associated with shorter duration of SE and ICU and hospital stays compared to the use of a second-line nonanesthetic antiseizure drug instead of or before anesthetics, without an associated increase in complications.

Keywords AgedAged, 80 and overAnticonvulsants / administration & dosageBenzodiazepines / administration & dosageComa / chemically inducedElectroencephalographyFemaleHospital MortalityHumansIntensive Care UnitsLength of StayMaleMiddle AgedOutcome and Process Assessment, Health Care / standardsPractice Guidelines as TopicRetrospective StudiesSeverity of Illness IndexStatus Epilepticus / complicationsStatus Epilepticus / drug therapyStatus Epilepticus / therapy
PMID: 34045273
Full text
Research group Epilepsie et Chirurgie (149)
Swiss National Science Foundation: 320030_163398
Swiss National Science Foundation: CRSII5_180365
(ISO format)
DE STEFANO, Pia et al. Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus. In: Neurology, 2021, vol. 97, n° 6, p. e564-e576. doi: 10.1212/WNL.0000000000012292 https://archive-ouverte.unige.ch/unige:156472

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Deposited on : 2021-11-17

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