Abstract

BackgroundThe outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs. The purpose of this study was to analyze the treatment delay of SE in a prospectively recruited patient cohort. Improvements to the treatment process are suggested.MethodsConsecutive adult patients with SE were recruited in the emergency department of Kuopio University Hospital (KUH) between March 23 and December 31, 2015. SE was defined as a prolonged (> 5 min) epileptic seizure or recurrent tonic-clonic seizures (≥ 3 seizures within any 24 h). Diagnostic and treatment delays and the features of SE were subject to statistical analysis.ResultsWe recorded 151 cases of SE during the study period. First-line treatment was initiated outside of hospital in 79 cases (52.3%), with a significantly shorter median delay compared to intrahospital initiation (28 min vs. 2 h 5 min, p < 0.001). Forty-six episodes of SE (30.5%) were not recognized during the prehospital phase. The median delay in recognition of tonic-clonic SE (23 min) was significantly shorter than in focal aware (2 h 0 min, p = 0.045) or focal impaired awareness SE (2 h 25 min, p < 0.001). Second-line treatment was used in 91 cases (60.3%), with a median delay of 2 h 42 min. Anesthesia was used in seven cases (4.6%) with refractory SE, with a median delay of 6 h 40 min.ConclusionsSE is often not recognized during the prehospital phase of treatment, which delays the initiation of first-line treatment. Intrahospital delay could be reduced by streamlining patient transition between the three lines of treatment.

Highlights

  • The outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs

  • Study design and setting Our prospectively recruited study cohort consists of consecutive adult patients admitted to the emergency department (ED) of Kuopio University Hospital (KUH) due to prolonged or recurrent epileptic seizures, between March 23 and December 31, 2015

  • A large proportion of seizures began in a healthcare unit (20.5%) or a nursing home (13.2%)

Read more

Summary

Introduction

The outcome of status epilepticus (SE) can be improved by facilitating early recognition and treatment with antiepileptic drugs. The purpose of this study was to analyze the treatment delay of SE in a prospectively recruited patient cohort. Improvements to the treatment process are suggested. Status epilepticus (SE) is an abnormally prolonged epileptic seizure that may cause long-term neurologic complications [1]. The International League Against Epilepsy (ILAE) has defined two critical time points during seizure; seizures that continue beyond time point t1 are prolonged and seldom cease spontaneously. The pathophysiology of SE involves the failure of endogenous seizure inhibition or the initiation of a mechanism that leads to an abnormally prolonged seizure [1]. The seizure triggers molecular mechanisms that promote receptor trafficking and altered neuropeptide expression, which cause sustained hyperexcitation in the affected neuronal network [3]. As the seizure duration grows, GABAergic anticonvulsants lose their potency [4] and the risk of refractory seizure [5] and adverse outcome increases [6]

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call