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Acute antiepileptic drug use in intensive care units

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Abstract

Background

In intensive care units (ICUs), antiepileptic drugs (AEDs) are used for manifold indications. This is the first study to assess the prevalence of acute AED use in ICUs and to identify associated clinical variables.

Methods

All patients in seven adult ICUs of a German university hospital in 2016 were retrospectively evaluated. Data were extracted from the computerized critical care information system and manually reviewed. Acute AED treatments were defined as initiated during ICU treatment or ≤ 6 h before ICU admission, excluding benzodiazepines and sedatives.

Results

Among 2335 patients evaluated, 8.8% received acutely started AEDs: 5.1% due to epileptic seizures, mostly acute symptomatic, and 3.7% for other indications like pain, post-hypoxic myoclonus, and singultus. Following multivariable analyses, acute AED use was independently associated with intracranial reasons for ICU admission and long durations of ICU stay, but not with increased disease severity scores or mortality. Levetiracetam was the substance most frequently used to treat epileptic seizures (88%) as was pregabalin for other conditions (49%). Among surviving patients, acute AEDs were continued beyond ICU discharge in 86% if seizure-related and in 78% if not seizure-related, even if there was no evident need for long-term AED treatment.

Conclusions

One out of eleven ICU patients receives acute AEDs, in almost half of cases for non-seizure indications. Acute AED use is a marker for intracranial ICU indications and prolonged ICU treatments. Usually, newer-generation AEDs are employed with favourable pharmacokinetic and safety profiles. However, whenever possible, acutely started AED should be discontinued before discharge from ICU.

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Acknowledgements

BV was funded by a grant of the von Bodelschwingh Foundation. MH holds the ‘Friedrich-von-Bodelschwingh Endowed Professorship for Clinical and Experimental Epileptology’ at the Department of Neurology, Charité–Universitätsmedizin Berlin. The authors wish to thank Dr Gerald Vorderwülbecke for designing Fig. 2.

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Authors and Affiliations

  1. Department of Neurology, Epilepsy-Center Berlin-Brandenburg, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany

    Bernd J. Vorderwülbecke & Martin Holtkamp

  2. Department of Anesthesiology and Operative Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany

    Gregor Lichtner & Falk von Dincklage

Authors
  1. Bernd J. Vorderwülbecke
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  2. Gregor Lichtner
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  3. Falk von Dincklage
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  4. Martin Holtkamp
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Corresponding author

Correspondence to Bernd J. Vorderwülbecke.

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Conflicts of interest

BJV, GL, and FvD declare that they have no conflict of interest. MH received speaker’s honoraria and/or consultancy fees from Bial, Desitin, Eisai, LivaNova, Novartis, and UCB.

Ethical standards

The study was approved by the institutional research committee at Charité–Universitätsmedizin Berlin. All procedures were in accordance with the ethical standards laid down in the 1964 Helsinki declaration and its later amendments. For this retrospective study, formal consent was not required.

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Vorderwülbecke, B.J., Lichtner, G., von Dincklage, F. et al. Acute antiepileptic drug use in intensive care units. J Neurol 265, 2841–2850 (2018). https://doi.org/10.1007/s00415-018-9069-3

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  • DOI: https://doi.org/10.1007/s00415-018-9069-3

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