Analysis of the factors associated with failure of generalized convulsive status epilepticus initial treatment

Abstract

Objective To analyze the clinical and electroencephalography (EEG) data associated with failure of adult generalized convulsive status epilepticus (GCSE) patients after initial treatment and to establish more reasonable strategies for GCSE patients. Methods Patients divided into 2 groups (full control group and seizure relapse group) were derived from emergency department and neuro-intensive care unit (NICU) of Xuanwu Hospital from 2007 to 2012.Pooled data originated from 2 randomized controlled trials were collected.Seizure relapse rate，continuous electroencephalography (cEEG) patterns and antiepileptic drugs (AEDs) plasma concentrations were analyzed after 6 h of GCSE initial treatment. Results There were statistically differences between seizure relapse group and full control group for etiology，GCSE duration before treatment and EEG patterns.By further multi-factor logistic regression，interictal epileptiform discharges (IEDs) and periodic epileptic discharges and (or) non-con vulsive status epilepticus (PEDs/NCSE) patterns were associated with seizure relapse independently (OR=5.486，95% CI 1.708-17.621; OR=21.056，95% CI 3.653-121.371，P 4 h) were associated with IEDs and PEDs/NCSE patterns independently (OR=10.433，95% CI 3.223-33.769; OR=5.381，95% CI 1.918-15.096 respectively). Conclusions It is a crucial method for clinicians to judge seizure termination by EEG after initially intravenous AEDs treatment for GCSE patients.Clinicians should individualize anti-epileptic strategies according to these factors so as to avoid of seizure relapse. Key words: Status epilepticus; Anticonvulsants; Treatment failure; Electroencephalography