Abstracts

Rationale: While several strategies have been posited for the management of status epilepticus (SE), it remains unclear whether a particular type of antiepileptic drug (AED) is more effective in treating SE, or is related to clinical outcome. The primary goal of this study was to determine whether AED type is associated with good clinical outcome. As physiologic changes associated with refractory seizures occur the longer SE remains untreated, the secondary goal of this analysis was to determine whether shorter latency to SE treatment (LTSE) correlated with type of AED.Methods: We conducted a retrospective analysis of patients diagnosed with SE at a university hospital from 1/1/05-10/31/12. The identity of the first-, second- and third-line AEDs (AED1, AED2, AED3) used to treat SE was recorded. Classes of AEDs included benzodiazepines (BZP, phenytoin (PHT), levetiracetam (LEV), valproate (VPA), and barbituates. The primary outcome measure was good outcome at hospital discharge, defined as a modified Rankin scale score (mRS) of 0-2. In addition to determining whether outcome differed when comparing all AEDS to each other in the AED1, AED2 and AED3 groups, the 3 most frequently used AEDs within each group were analyzed in pairs; further direct comparison was limited by sample size. A subgroup analysis was performed in which AED cohorts were divided into groups by LTSE using 4 cut-off times, measured in minutes: LTSE 10 vs. >10; 30 vs. >30; 60 vs. >60; and 120 vs. >120. Logistic regression and the Pearson Chi-Square test were used to analyze nominal data. Significance was set at p=0.05.Results: The cohort consisted of 151 cases of SE. Mean age was 59 years, and 45% (N=68) were male. A 2nd AED was used in 142 cases, and a 3rd AED was used in 123 cases. For the AED1, AED2 and AED3 groups, the most frequently used AEDs were BZP (N=115, 76.2%), PHT (N=12, 7.9%), LEV (N=11, 7.3%); PHT (N=60, 42.3%), LEV (N=42, 29.6%), BZP (N=7, 4.9%); and LEV (N=40, 32.5%), PHT (N=18, 14.6%), VPA (N=15, 12.2%), respectively. There was no significant association between AED type and good outcome among the 3 groups. When LTSE was taken into account, a significant difference between AEDs was present for AED2 at LTSE 30 and 60 minutes (p=0.03, CI 0.15-0.91 and p=0.03, CI 0.13-0.91), and for AED3 at LTSE 10, 30 and 60 minutes (p=0.04, CI 0.11-0.93; p=0.01, CI 0.09-0.75; and p=0.02, CI 0.08-0.78). Of the most frequently used AEDs among the three groups, there was a trend towards better outcome when using LEV compared to PHT as the third AED if initiated within 120 minutes of SE onset (p=0.056). Further AED to AED comparison was limited by sample size.Conclusions: Good clinical outcome is not significantly associated with the initial AED type used to treat SE, even when LTSE is taken into account. Among the second and third AEDs used to treat SE, a significant difference was present among the AEDs used in this cohort if treatment was initiated within 60 minutes. There was a trend for better clinical outcome with LEV compared to PHT as the third AED used, however, further direct AED to AED comparison was limited by sample size.