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Luo Q, Lai R, Su M, Wu Z, Feng H, Zhou H. Risk factors and a predictive model for the occurrence of adverse outcomes in patients with new-onset refractory status epilepsy. Front Mol Neurosci 2024; 17:1360949. [PMID: 38699485 PMCID: PMC11064924 DOI: 10.3389/fnmol.2024.1360949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives To determine risk factors for the occurrence of adverse outcomes in patients with new-onset refractory status epilepsy (NORSE) and to construct a concomitant nomogram. Methods Seventy-six adult patients with NORSE who were admitted to the Department of Neurology, First Affiliated Hospital of Sun Yat-sen University between January 2016 and December 2022 were enrolled for the study. Participants were divided into two-those with good and poor functional outcomes-and their pertinent data was obtained from the hospital medical recording system. Univariate analysis was used to identify potential causes of poor outcomes in both groups and a multivariate logistic regression model was used to identify risk factors for the occurrence of poor outcomes. Using the R programming language RMS package, a nomogram was created to predict the occurrence of poor outcomes. Results The NORSE risk of adverse outcome nomogram model included four predictors, namely duration of mechanical ventilation (OR = 4.370, 95% CI 1.221-15.640, p = 0.023), antiviral therapy (OR = 0.045, 95% CI 0.005-0.399, p = 0.005), number of anesthetics (OR = 13.428, 95% CI 2.16-83.48, p = 0.005) and neutrophil count/lymphocyte count ratio (NLR) (OR = 5.248, 95% CI 1.509-18.252, p = 0.009). The nomogram had good consistency and discrimination in predicting risk and can thus assist clinical care providers to assess outcomes for NORSE patients. Through ordinary bootstrap analyses, the results of the original set prediction were confirmed as consistent with those of the test set. Conclusion The nomogram model of risk of adverse outcomes in NORSE adult patients developed in this study can facilitate clinicians to predict the risk of adverse outcomes in NORSE patients and make timely and reasonable interventions for patients at high risk of adverse outcomes.
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Affiliation(s)
- Qiuyan Luo
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Neurology, Guangzhou Woman and Children’s Medical Centre, Guangzhou, China
| | - Rong Lai
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Miao Su
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zichao Wu
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huiyu Feng
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongyan Zhou
- Neurological Intensive Unit, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Benghanem S, Robieux EP, Neligan A, Walker MC. Status epilepticus: what's new for the intensivist. Curr Opin Crit Care 2024; 30:131-141. [PMID: 38441162 DOI: 10.1097/mcc.0000000000001137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW Status epilepticus (SE) is a common neurologic emergency affecting about 36.1/100 000 person-years that frequently requires intensive care unit (ICU) admission. There have been advances in our understanding of epidemiology, pathophysiology, and EEG monitoring of SE, and there have been large-scale treatment trials, discussed in this review. RECENT FINDINGS Recent changes in the definitions of SE have helped guide management protocols and we have much better predictors of outcome. Observational studies have confirmed the efficacy of benzodiazepines and large treatment trials indicate that all routinely used second line treatments (i.e., levetiracetam, valproate and fosphenytoin) are equally effective. Better understanding of the pathophysiology has indicated that nonanti-seizure medications aimed at underlying pathological processes should perhaps be considered in the treatment of SE; already immunosuppressant treatments are being more widely used in particular for new onset refractory status epilepticus (NORSE) and Febrile infection-related epilepsy syndrome (FIRES) that sometimes revealed autoimmune or paraneoplastic encephalitis. Growing evidence for ICU EEG monitoring and major advances in automated analysis of the EEG could help intensivist to assess the control of electrographic seizures. SUMMARY Research into the morbi-mortality of SE has highlighted the potential devastating effects of this condition, emphasizing the need for rapid and aggressive treatment, with particular attention to cardiorespiratory and neurological complications. Although we now have a good evidence-base for the initial status epilepticus management, the best treatments for the later stages are still unclear and clinical trials of potentially disease-modifying therapies are long overdue.
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Affiliation(s)
- Sarah Benghanem
- Medical Intensive Care Unit, Cochin hospital, APHP.Centre
- University of Paris cite - Medical School
- INSERM 1266, psychiatry and neurosciences institute of Paris (IPNP)
| | - Estelle Pruvost Robieux
- University of Paris cite - Medical School
- INSERM 1266, psychiatry and neurosciences institute of Paris (IPNP)
- Neurophysiology and epileptology department, Sainte Anne hospital, Paris, France
| | - Aidan Neligan
- Homerton University Hospital NHS Foundation Trust, Homerton Row
- UCL Queen Square Institute of Neurology, Queen Square, London
- Centre for Preventive Neurology, Wolfson Institute of Population Health, QMUL, UK
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Dhoisne M, Delval A, Mathieu D, Mazeraud A, Bournisien L, Derambure P, Tortuyaux R. Seizure recurrences in generalized convulsive status epilepticus under sedation: What are its predictors and its impact on outcome? Rev Neurol (Paris) 2023:S0035-3787(23)01112-8. [PMID: 38052663 DOI: 10.1016/j.neurol.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome. OBJECTIVE To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV). METHODS We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors. RESULTS Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days. CONCLUSIONS Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.
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Affiliation(s)
- M Dhoisne
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France
| | - A Delval
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - D Mathieu
- Intensive Care Unit, CHU de Lille, Lille, France
| | - A Mazeraud
- Service d'anesthésie-réanimation, GHU de Paris psychiatrie et neurosciences, Paris, France; Département neurosciences, unité perception et mémoire, Institut Pasteur, Paris, France
| | - L Bournisien
- Intensive Care Unit, CHU de Lille, Lille, France
| | - P Derambure
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Inserm, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - R Tortuyaux
- Department of Clinical Neurophysiology, hôpital Roger-Salengro, CHU de Lille, avenue du Professeur-Emile-Laine, 59000 Lille, France; Intensive Care Unit, CHU de Lille, Lille, France.
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Donoso-Calero MI, Martín Conty JL, López-Izquierdo R, Sanz-García A, Dileone M, Polonio-López B, Mordillo-Mateos L, Delgado Benito JF, Del Pozo Vegas C, Mohedano-Moriano A, Martín-Rodríguez F. Prehospital seizures: Short-term outcomes and risk stratification based in point-of-care testing. Eur J Clin Invest 2023; 53:e14042. [PMID: 37325996 DOI: 10.1111/eci.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Information for treatment or hospital derivation of prehospital seizures is limited, impairing patient condition and hindering patients risk assessment by the emergency medical services (EMS). This study aimed to determine the associated factors to clinical impairment, and secondarily, to determine risk factors associated to cumulative in-hospital mortality at 2, 7 and 30 days, in patients presenting prehospital seizures. METHODS Prospective, multicentre, EMS-delivery study involving adult subjects with prehospital seizures, including five advanced life support units, 27 basic life support units and four emergency departments in Spain. All bedside variables: including demographic, standard vital signs, prehospital laboratory tests and presence of intoxication or traumatic brain injury (TBI), were analysed to construct a risk model using binary logistic regression and internal validation methods. RESULTS A total of 517 patients were considered. Clinical impairment was present in 14.9%, and cumulative in-hospital mortality at 2, 7 and 30-days was 3.4%, 4.6% and 7.7%, respectively. The model for the clinical impairment indicated that respiratory rate, partial pressure of carbon dioxide, blood urea nitrogen, associated TBI or stroke were risk factors; higher Glasgow Coma Scale (GCS) scores mean a lower risk of impairment. Age, potassium, glucose, prehospital use of mechanical ventilation and concomitant stroke were risk factors associated to mortality; and oxygen saturation, a high score in GCS and haemoglobin were protective factors. CONCLUSION Our study shows that prehospital variables could reflect the clinical impairment and mortality of patients suffering from seizures. The incorporation of such variables in the prehospital decision-making process could improve patient outcomes.
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Affiliation(s)
- María I Donoso-Calero
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - José L Martín Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Michele Dileone
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Neurology Department, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | | | | | | | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Alvarez V, Novy J, Beuchat I, Rossetti AO. Letter to the editor regarding "early timing of anesthesia in status epilepticus is associated with complete recovery: A 7-year retrospective two-center study". Epilepsia 2023; 64:2530-2531. [PMID: 37376780 DOI: 10.1111/epi.17705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/26/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Vincent Alvarez
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Jan Novy
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Isabelle Beuchat
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
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Vieille T, Jacq G, Merceron S, Huriaux L, Chelly J, Quenot JP, Legriel S. Management and outcomes of critically ill adult patients with convulsive status epilepticus and preadmission functional impairments. Epilepsy Behav 2023; 141:109083. [PMID: 36803873 DOI: 10.1016/j.yebeh.2023.109083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/31/2022] [Accepted: 01/01/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE Functional status is among the criteria relevant to decisions about intensive care unit (ICU) admission and level of care. Our main objective was to describe the characteristics and outcomes of adult patients requiring ICU admission for Convulsive Status Epilepticus (CSE) according to whether their functional status was previously impaired. METHODS We retrospectively analyzed data from consecutive adults who were admitted to two French ICUs for CSE between 2005 and 2018 and then included them retrospectively in the Ictal Registry. Pre-existing functional impairment was defined as a Glasgow Outcome Scale (GOS) score of 3 before admission. The primary outcome measure was a loss of ≥1 GOS score point at 1 year. Multivariate analysis was used to identify factors associated with this measure. RESULTS The 206 women and 293 men had a median age of 59 years [47-70 years]. The preadmission GOS score was 3 in 56 (11.2%) patients and 4 or 5 in 443 patients. Compared to the GOS-4/5 group, the GOS-3 group was characterized by a higher frequency of treatment-limitation decisions (35.7% vs. 12%, P < 0.0001), similar ICU mortality (19.6 vs. 13.1, P = 0.22), higher 1-year mortality (39.3% vs. 25.6%, P < 0.01), and a similar proportion of patients with no worsening of the GOS score at 1 year (42.9 vs. 44.1, P = 0.89). By multivariate analysis, not achieving a favorable 1-year outcome was associated with age above 59 years (OR, 2.36; 95%CI, 1.55-3.58, P < 0.0001), preexisting ultimately fatal comorbidity (OR, 2.92; 95%CI, 1.71-4.98, P = 0.0001), refractory CSE (OR, 2.19; 95%CI, 1.43-3.36, P = 0.0004), cerebral insult as the cause of CSE (OR, 2.75; 95%CI, 1.75-4.27, P < 0.0001), and Logistic Organ Dysfunction score ≥ 3 at ICU admission (OR, 2.08; 95%CI, 1.37-3.15, P = 0.0006). A preadmission GOS score of 3 was not associated with a functional decline during the first year (OR, 0.61; 95%CI, 0.31-1.22, P = 0.17). SIGNIFICANCE Preadmission functional status in adult patients with CSE is not independently associated with a functional decline during the first postadmission year. This finding may help physicians make ICU admission decisions and adult patients write advance directives. STUDY REGISTRATION #NCT03457831.
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Affiliation(s)
- Thibault Vieille
- Department of Intensive Care, Burgundy University Hospital, Dijon, France; IctalGroup, Le Chesnay, France.
| | - Gwenaëlle Jacq
- IctalGroup, Le Chesnay, France; Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France; UVSQ, INSERM, University Paris-Saclay, CESP, PsyDev Team, 94800 Villejuif, France.
| | - Sybille Merceron
- IctalGroup, Le Chesnay, France; Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France.
| | - Laetitia Huriaux
- IctalGroup, Le Chesnay, France; Intensive Care Unit, Centre Hospitalier Intercommunal Toulon La Seyne-sur-Mer, Toulon, France.
| | - Jonathan Chelly
- IctalGroup, Le Chesnay, France; Intensive Care Unit, Centre Hospitalier Intercommunal Toulon La Seyne-sur-Mer, Toulon, France.
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, Dijon, France; IctalGroup, Le Chesnay, France; Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France; INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France.
| | - Stéphane Legriel
- IctalGroup, Le Chesnay, France; Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150 Le Chesnay Cedex, France; UVSQ, INSERM, University Paris-Saclay, CESP, PsyDev Team, 94800 Villejuif, France.
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7
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Sharshar T, Porcher R, Asfar P, Grimaldi L, Jabot J, Argaud L, Lebert C, Bollaert PE, Harlay ML, Chillet P, Maury E, Santoli F, Blanc P, Sonneville R, Vu DC, Rohaut B, Mazeraud A, Alvarez JC, Navarro V, Clair B, Outin H, Azabou E, Beloncle F, Ben-Hadj O, Blanc P, Bollaert PE, Bolgert F, Bouadma L, Chillet P, Clair B, Corne P, Clere-Jehl R, Cour M, Crespel A, Déiler V, Dellamonica J, Demeret S, Harley ML, Henry-Lagarrigue M, Jabot J, Heming N, Hernu R, Kouatchet A, Lebert C, Lerolle N, Maury E, Letrou S, Mazeraud A, Mercat A, Mortaza S, Mourvillier B, Outin H, Paugham-Burtz C, Pierrot M, Provent M, Rohaut B, De La Salle S, Santoli F, Schenk M, Siami S, Souday V, Sharshar T, Sonneville R, Timsit JF, Thuong M, Weiss N. Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial. Crit Care 2023; 27:8. [PMID: 36624526 PMCID: PMC9830759 DOI: 10.1186/s13054-022-04292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Generalised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20-40% patients and is associated with protracted hospitalisation, disability, and mortality. The objective was to determine whether valproic acid (VPA) as complementary treatment to the stepwise strategy improves the outcomes of patients with de novo established GCSE. METHODS This was a multicentre, double-blind, randomised controlled trial in 244 adults admitted to intensive care units for GCSE in 16 French hospitals between 2013 and 2018. Patients received standard care of benzodiazepine and a second-line ASM (except VPA). Intervention patients received a 30 mg/kg VPA loading dose, then a 1 mg/kg/h 12 h infusion, whilst the placebo group received an identical intravenous administration of 0.9% saline as a bolus and continuous infusion. Primary outcome was proportion of patients discharged from hospital by day 15. The secondary outcomes were seizure control, adverse events, and cognition at day 90. RESULTS A total of 126 (52%) and 118 (48%) patients were included in the VPA and placebo groups. 224 (93%) and 227 (93%) received a first-line and a second-line ASM before VPA or placebo infusion. There was no between-group difference for patients hospital-discharged at day 15 [VPA, 77 (61%) versus placebo, 72 (61%), adjusted relative risk 1.04; 95% confidence interval (0.89-1.19); p = 0.58]. There were no between-group differences for secondary outcomes. CONCLUSIONS VPA added to the recommended strategy for adult GCSE is well tolerated but did not increase the proportion of patients hospital-discharged by day 15. TRIAL REGISTRATION NO NCT01791868 (ClinicalTrials.gov registry), registered: 15 February 2012.
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Affiliation(s)
- Tarek Sharshar
- grid.508487.60000 0004 7885 7602Neuro-Intensive Care Medicine, Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France
| | - Raphaël Porcher
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004 Paris, France ,grid.411394.a0000 0001 2191 1995Centre d’Epidémiologie Clinique, AP-HP, Hôpital Hôtel Dieu, F-75004 Paris, France
| | - Pierre Asfar
- grid.411147.60000 0004 0472 0283Department of Medical Intensive Care, University Hospital, Angers, France
| | - Lamiae Grimaldi
- grid.50550.350000 0001 2175 4109Clinical Research Unit, Assistance Publique - Hôpitaux de Paris University Paris-Saclay. Faculty of medicine, University of Versailles Saint-Quentin en Yvelines. Inserm U1018 Team Anti-infective evasion and pharmacoepidemiology, Boulogne-Billancourt, France
| | - Julien Jabot
- Medical-Surgical Intensive Care Unit, CHU Felix-Guyon, Saint-Denis, La Réunion, France
| | - Laurent Argaud
- grid.412180.e0000 0001 2198 4166Service de Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Christine Lebert
- grid.477015.00000 0004 1772 6836Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, La Roche-sur-Yon, France
| | - Pierre-Edouard Bollaert
- grid.29172.3f0000 0001 2194 6418CHRU-Nancy, Service de Médecine Intensive Réanimation, Université de Lorraine, 54000 Nancy, France
| | - Marie Line Harlay
- grid.412201.40000 0004 0593 6932Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Patrick Chillet
- Service de Médecine Intensive - Réanimation, Centre hospitalier Léon Bourgeois, Châlons en Champagne, France
| | - Eric Maury
- grid.462844.80000 0001 2308 1657Service de Médecine Intensive et Réanimation Hôpital Saint-Antoine, Paris-Sorbonne Université, Paris, France
| | - Francois Santoli
- grid.414308.a0000 0004 0594 0368Médecine Intensive—Réanimation, Centre Hospitalier Robert Ballanger, Aulnay sous Bois, France
| | - Pascal Blanc
- grid.440383.80000 0004 1765 1969Réanimation Médico Chirurgicale, Centre Hospitalier René Dubos, Pontoise, France
| | - Romain Sonneville
- Université de Paris Cité, INSERM UMR1137, Paris, France ,grid.411119.d0000 0000 8588 831XAPHP Nord, Médecine Intensive – Réanimation, Hôpital Bichat—Claude Bernard, Paris, France
| | - Dinh Chuyen Vu
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Rohaut
- grid.462844.80000 0001 2308 1657Department of Neurology, Neuro-ICU & Brain institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France
| | - Aurelien Mazeraud
- grid.508487.60000 0004 7885 7602Anaesthesiology and ICU Department, GHU-Psychiatry and Neurosciences, Pole Neuro, Sainte-Anne Hospital, Perception and Memory Unit, Neurosciences Department, Institut Pasteur, Université Paris Cité, Paris, France
| | - Jean-Claude Alvarez
- grid.12832.3a0000 0001 2323 0229Department of Pharmacology and Toxicology, Inserm U-1173, Raymond Poincare Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, 104 Boulevard Raymond Poincare, 92380 Garches, France
| | - Vincent Navarro
- grid.425274.20000 0004 0620 5939AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, Sorbonne Université, and Paris Brain Institute, Paris, France
| | - Bernard Clair
- grid.12832.3a0000 0001 2323 0229General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Hervé Outin
- grid.418056.e0000 0004 1765 2558Intensive Care Unit Centre Hospitalier Intercommunal, Poissy/Saint-Germain-en-Laye, France
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8
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Jacq G, Chelly J, Quenot JP, Soulier P, Lesieur O, Beuret P, Holleville M, Bruel C, Bailly P, Sauneuf B, Sejourne C, Rigaud JP, Galbois A, Arrayago M, Plantefeve G, Stoclin A, Schnell D, Fontaine C, Perier F, Bougouin W, Pichon N, Mongardon N, Ledoux D, Lascarrou JB, Legriel S. Multicentre observational status-epilepticus registry: protocol for ICTAL. BMJ Open 2022; 12:e059675. [PMID: 35168989 PMCID: PMC8852755 DOI: 10.1136/bmjopen-2021-059675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Status epilepticus (SE) is a common life-threatening neurological emergency that can cause long-term impairments. Overall outcomes remain poor. Major efforts are required to clarify the epidemiology of SE and the determinants of outcomes, thereby identifying targets for improved management. METHODS AND ANALYSIS ICTAL Registry is a multicentre open cohort of critically ill patients with convulsive, non-convulsive or psychogenic non-epileptic SE. Observational methods are applied to collect uniform data. The goal of the ICTAL Registry is to collect high-quality information on a large number of patients, thereby allowing elucidation of the pathophysiological mechanisms involved in mortality and morbidity. The registry structure is modular, with a large core data set and the opportunity for research teams to create satellite data sets for observational or interventional studies (eg, cohort multiple randomised controlled trials, cross-sectional studies and short-term and long-term longitudinal outcome studies). The availability of core data will hasten patient recruitment to studies, while also decreasing costs. Importantly, the vast amount of data from a large number of patients will allow valid subgroup analyses, which are expected to identify patient populations requiring specific treatment strategies. The results of the studies will have a broad spectrum of application, particularly given the multidisciplinary approach used by the IctalGroup research network. ETHICS AND DISSEMINATION The ICTAL Registry protocol was approved by the ethics committee of the French Intensive Care Society (#CE_SRLF 19-68 and 19-68a). Patients or their relatives/proxies received written information to the use of the retrospectively collected and pseudonymised data, in compliance with French law. Prospectively included patients receive written consent form as soon as they recover decision-making competency; if they refuse consent, they are excluded from the registry. Data from the registry will be disseminated via conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03457831.
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Affiliation(s)
- Gwenaelle Jacq
- Service de réanimation et unité de soins continus, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jonathan Chelly
- Service de réanimation, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Toulon, France
| | | | - Pauline Soulier
- Service de réanimation, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - Olivier Lesieur
- Service de réanimation, Centre hospitalier de la Rochelle, La Rochelle, Nouvelle-Aquitaine, France
| | - Pascal Beuret
- Service de Réanimation et Soins Continus, Centre Hospitalier de Roanne, Roanne, Rhône-Alpes, France
| | | | - Cedric Bruel
- Service de réanimation, Groupe hospitalier Paris Saint Joseph, Paris, France
| | - Pierre Bailly
- Médecine Intensive Réanimation, CHU de Brest, Brest, France
| | - Bertrand Sauneuf
- Service de réanimation, Centre Hospitalier Louis Pasteur de Cherbourg, Cherbourg-Octeville, Basse-Normandie, France
| | | | - Jean Philippe Rigaud
- Service de réanimation, Centre Hospitalier de Dieppe, Dieppe, Haute-Normandie, France
| | - Arnaud Galbois
- Intensive Care Unit, Claude Galien Private Hospital, Quincy-sous-Senart, Île-de-France, France
| | - Marine Arrayago
- Department of Intensive Care, Cannes Hospital, Cannes, France
| | - Gaetan Plantefeve
- Service de Médecine Intensive Réanimation, Centre Hospitalier d'Argenteuil, Argenteuil, Île-de-France, France
| | | | - David Schnell
- Service de réanimation, Hospital Centre Angouleme, Angouleme, Poitou-Charentes, France
| | - Candice Fontaine
- Service de réanimation et unité de soins continus, Centre Hospitalier de Versailles, Le Chesnay, France
| | - François Perier
- Service de réanimation et unité de soins continus, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Wulfran Bougouin
- Intensive Care Unit, Jacques Cartier Private Hospital, Massy, France
| | - Nicolas Pichon
- Service de réanimation, Centre Hospitalier de Brive, Brive-la-Gaillarde, France
| | - Nicolas Mongardon
- Service de Médecine Intensive-Réanimation, Hôpital Henri Mondor, Creteil, Île-de-France, France
| | - Didier Ledoux
- Department of Intensive Care, University Hospital of Liege, Sart, Belgium
| | | | - Stephane Legriel
- Service de réanimation et unité de soins continus, Centre Hospitalier de Versailles, Le Chesnay, France
- University Paris-Saclay, UVSQ, INSERM, Team « PsyDev », CESP, Villejuif, France
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Affiliation(s)
- Hervé Outin
- Service de réanimation médico-chirurgicale, Centre hospitalier intercommunal de Poissy, Saint-Germain en Laye
| | - Hugues Lefort
- Structure des urgences, Hôpital d'Instruction des Armées Legouest, Metz
| | - Vincent Peigne
- Service de Réanimation, Centre Hospitalier Métropole-Savoie, Chambéry, France
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