Factors associated with the use of anesthetic drug infusion in patients with status epilepticus and their relation to outcome: a prospective study

Abstract

Status epilepticus (SE) is one of the most dreadful neurological emergencies; unfortunately, studies targeting SE are still inadequate. This study aims to identify factors associated with the use of CIVAD in patients presenting with status epilepticus and detect those impact the clinical outcome. A prospective study involving 144 episodes of SE in 144 patients. Patients were categorized according to whether or not they received CIVAD. Subjects underwent clinical assessment, brain imaging, and EEG. The consciousness level was assessed using the Glasgow coma scale (GCS) and the Full outline of responsiveness (FOUR) scale. SE severity score (STESS) and Epidemiology-based mortality score (EMSE) were used as scales for outcome prediction. Continuous IV anesthetic drug infusion was initiated in 36% of patients (+ CIVAD). Such groups showed a significantly worse initial level of consciousness (< 0.001), an unstable course of seizure evolution (0.009), and all of them showed abnormal EEG patterns. A significantly higher number of patients (+ CIVAD) developed complications (< 0.001), had higher outcome prediction scores (< 0.001), and mortality rates (< 0.001) compared to those who did not need CIVAD (− CIVAD). Mortality was associated with acute symptomatic etiology and higher total doses of propofol. Among the study population, mortality among patients who received CIVAD was associated with acute symptomatic SE and prolonged propofol infusion rather than any clinical parameters or predictor scores.

This is a preview of subscription content, access via your institution.

Data availability

Data are available on request due to privacy/ethical restrictions.

References

  1. 1.

    Trinka E, Höfler J, Leitinger M, Brigo F (2015) Pharmacotherapy for status epilepticus. Drugs. https://doi.org/10.1007/s40265-015-0454-2

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Lado FA, Moshé SL (2008) How do seizures stop? Epilepsia 49:1651–1664. https://doi.org/10.1111/j.1528-1167.2008.01669.x

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hocker S, Abou-Khalil B (2016) Role of anesthetics in treating status epilepticus: one more piece in the puzzle. Neurology 87:1636–1637. https://doi.org/10.1212/WNL.0000000000003240

    Article  PubMed  Google Scholar 

  4. 4.

    Sutter R, Kaplan PW (2015) Can anesthetic treatment worsen outcome in status epilepticus? Epilepsy Behav 49:294–297. https://doi.org/10.1016/j.yebeh.2015.02.044

    Article  PubMed  Google Scholar 

  5. 5.

    Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S et al (2015) A definition and classification of status epilepticus—report of the ILAE task force on classification of status epilepticus. Epilepsia 56:1515–1523. https://doi.org/10.1111/epi.13121

    Article  PubMed  Google Scholar 

  6. 6.

    Walker M (2005) Status epilepticus: an evidence based guide. BMJ 331:673–677. https://doi.org/10.1136/bmj.331.7518.673

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Leitinger M, Beniczky S, Rohracher A, Gardella E, Kalss G, Qerama E et al (2015) Salzburg consensus criteria for non-convulsive status epilepticus–approach to clinical application. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2015.05.007

    Article  PubMed  Google Scholar 

  8. 8.

    Engel J (2006) Report of the ILAE classification core group. Epilepsia 47:1558–1568. https://doi.org/10.1111/j.1528-1167.2006.00215.x

    Article  PubMed  Google Scholar 

  9. 9.

    Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE et al (2014) ILAE official report: a practical clinical definition of epilepsy. Epilepsia 55:475–482. https://doi.org/10.1111/epi.12550

    Article  PubMed  Google Scholar 

  10. 10.

    Teasdale G, Jennett B (1974) Assessment of coma and consciousness: a practical scale. Lancet 304:81–84

    Article  Google Scholar 

  11. 11.

    Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 34:45–55. https://doi.org/10.1007/BF01405862

    CAS  Article  Google Scholar 

  12. 12.

    Wijdicks EFM, Bamlet WR, Maramattom BV, Manno EM, McClelland RL (2005) Validation of a new coma scale: the FOUR score. Ann Neurol. https://doi.org/10.1002/ana.20611

    Article  PubMed  Google Scholar 

  13. 13.

    Tindall SC. Level of Consciousness. Clin Methods Hist Phys Lab Exam 1990:296–9. NBK380 [bookaccession].

  14. 14.

    Jasper H (1958) Report of the committee on methods of clinical examination in electroencephalography. Electroencephalogr Clin Neurophysiol 10:370–375

    Article  Google Scholar 

  15. 15.

    Hirsch LJ, Laroche SM, Gaspard N, Gerard E, Svoronos A, Herman ST et al (2013) American clinical neurophysiology society’s standardized critical care EEG terminology: 2012 version. J Clin Neurophysiol. https://doi.org/10.1097/WNP.0b013e3182784729

    Article  PubMed  Google Scholar 

  16. 16.

    Leitinger M, Höller Y, Kalss G, Rohracher A, Novak HF, Höfler J et al (2015) Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care 22:273–282. https://doi.org/10.1007/s12028-014-0080-y

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T et al (2018) Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia. https://doi.org/10.1111/epi.14016

    Article  PubMed  Google Scholar 

  18. 18.

    Rossetti AO, Logroscino G, Bromfield EB (2006) A clinical score for prognosis of status epilepticus in adults. Neurology. https://doi.org/10.1212/01.wnl.0000223352.71621.97

    Article  PubMed  Google Scholar 

  19. 19.

    Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB (2008) Status epilepticus severity score (STESS): a tool to orient early treatment strategy. J Neurol. https://doi.org/10.1007/s00415-008-0989-1

    Article  PubMed  Google Scholar 

  20. 20.

    Chan YH (2003) Biostatistics 102: quantitative data - parametric & non-parametric tests. Singapore Med J 44:391–396

    CAS  PubMed  Google Scholar 

  21. 21.

    Chan YH (2004) Biostatistics 202: logistic regression analysis. Singapore Med J 45:149–153

    CAS  PubMed  Google Scholar 

  22. 22.

    Cormier J, MacIel CB, Gilmore EJ (2017) Ictal-interictal continuum: when to worry about the continuous electroencephalography pattern. Semin Respir Crit Care Med 38:793–806. https://doi.org/10.1055/s-0037-1607987

    Article  PubMed  Google Scholar 

  23. 23.

    Kapinos G, Trinka E, Kaplan PW (2018) Multimodal approach to decision to treat critically ill patients with periodic or rhythmic patterns using an ictal-interictal continuum spectral severity score. J Clin Neurophysiol 35:314–324. https://doi.org/10.1097/WNP.0000000000000468

    Article  PubMed  Google Scholar 

  24. 24.

    Rodríguez V, Rodden MF, LaRoche SM (2016) Ictal-interictal continuum: a proposed treatment algorithm. Clin Neurophysiol 127:2056–2064. https://doi.org/10.1016/j.clinph.2016.02.003

    Article  PubMed  Google Scholar 

  25. 25.

    Rubinos C, Reynolds AS, Claassen J (2018) The ictal-interictal continuum: to treat or not to treat (and how)? Neurocrit Care 29:3–8. https://doi.org/10.1007/s12028-017-0477-5

    Article  PubMed  Google Scholar 

  26. 26.

    Kinney MO, Kaplan PW (2017) An update on the recognition and treatment of non-convulsive status epilepticus in the intensive care unit. Expert Rev Neurother 17:987–1002. https://doi.org/10.1080/14737175.2017.1369880

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Atmaca MM, Bebek N, Baykan B, Gürses C (2017) Predictors of outcomes and refractoriness in status epilepticus : a prospective study. Epilepsy Behav 75:158–164. https://doi.org/10.1016/j.yebeh.2017.07.046

    Article  PubMed  Google Scholar 

  28. 28.

    Dubey D, Bhoi SK, Kalita J, Misra UK (2017) Spectrum and predictors of refractory status epilepticus in a developing country. Can J Neurol Sci 44:538–546. https://doi.org/10.1017/cjn.2017.28

    Article  PubMed  Google Scholar 

  29. 29.

    Novy J, Logroscino G, Rossetti AO (2010) Refractory status epilepticus: a prospective observational study. Epilepsia 51:251–256. https://doi.org/10.1111/j.1528-1167.2009.02323.x

    Article  PubMed  Google Scholar 

  30. 30.

    El-Tamawy MS, Amer H, Kishk NA, Nawito AM, Basheer MA, Alieldin N et al (2020) External validation of STESS and EMSE as outcome prediction scores in an Egyptian cohort with status epilepticus. Epilepsy Behav. https://doi.org/10.1016/j.yebeh.2019.106686

    Article  PubMed  Google Scholar 

  31. 31.

    Neligan A, Shorvon SD (2010) Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol 67:931–940. https://doi.org/10.1001/archneurol.2010.169

    Article  PubMed  Google Scholar 

  32. 32.

    Sutter R, Kaplan PW, Rüegg S (2013) Outcome predictors for status epilepticus - What really counts. Nat Rev Neurol 9:525–534. https://doi.org/10.1038/nrneurol.2013.154

    Article  PubMed  Google Scholar 

  33. 33.

    Trinka E, Höfler J, Zerbs A (2012) Causes of status epilepticus. Epilepsia 53:127–138. https://doi.org/10.1111/j.1528-1167.2012.03622.x

    Article  PubMed  Google Scholar 

  34. 34.

    Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J et al (2016) Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American epilepsy society. Epilepsy Curr 16:48–61. https://doi.org/10.5698/1535-7597-16.1.48

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Hocker S (2018) Anesthetic drugs for the treatment of status epilepticus. Epilepsia 59:188–192. https://doi.org/10.1111/epi.14498

    Article  PubMed  Google Scholar 

  36. 36.

    Giovannini G, Monti G, Tondelli M, Marudi A, Valzania F, Leitinger M et al (2017) Mortality, morbidity and refractoriness prediction in status epilepticus: comparison of STESS and EMSE scores. Seizure 46:31–37. https://doi.org/10.1016/j.seizure.2017.01.004

    Article  PubMed  Google Scholar 

  37. 37.

    Leitinger M, Trinka E, Giovannini G, Zimmermann G, Florea C, Rohracher A et al (2018) Epidemiology of status epilepticus in adults: a population-based study on incidence, causes, and outcomes. Epilepsia 60:1–10. https://doi.org/10.1111/epi.14607

    Article  Google Scholar 

  38. 38.

    Hassan H, Rajiv KR, Menon R (2016) An audit of the predictors of outcome in status epilepticus from a resource-poor country : a comparison with developed countries. Epileptic Disord 18:163–172

    Article  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Reham Shamloul.

Ethics declarations

Conflict of interest

Not applicable.

Ethical approval

The ethical committee of the neurology department, Cairo University, approved the study. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Written informed consent was requested from patients or their relatives in case of impaired patient level of consciousness.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shamloul, R., El-Tamawy, M., Amer, H. et al. Factors associated with the use of anesthetic drug infusion in patients with status epilepticus and their relation to outcome: a prospective study. Acta Neurol Belg (2021). https://doi.org/10.1007/s13760-021-01625-1

Download citation

Keywords

  • Status epilepticus
  • Outcome
  • Anesthesia
  • Mortality