Factors predicting cessation of status epilepticus in clinical practice – data from a prospective observational registry (SENSE)

Abstract

Objective

To investigate the initial termination rate of status epilepticus (SE) in a large observational study, and to explore associated variables.

Methods

Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni‐ and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE, GCSE) and 12 hours (for non‐GCSE) of initiating treatment.

Results

Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non‐GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE, and 73% in non‐GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of the GCSE patients and 78% of the non‐GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment, and in 342 non‐GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that the use of benzodiazepines as first treatment step, and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups.

Interpretation

In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This under‐dosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as first treatment step.

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