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Fernández Alonso C, González Martínez F, Alonso Avilés R, Liñán López M, Fuentes Ferrer ME, Gros Bañeres B. Risk model of seizure cluster or status epilepticus and intervention in the emergency department. Neurologia 2024; 39:20-28. [PMID: 38065430 DOI: 10.1016/j.nrleng.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores ≥ 3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥ 2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.
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Affiliation(s)
| | | | - R Alonso Avilés
- Hospital Universitario Clínico de Valladolid, Valladolid, Spain
| | - M Liñán López
- Hospital Neurotraumatológico Virgen de las Nieves de Granada, Granada, Spain
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of starting antiepileptic treatment prior to electroencephalography in first epileptic seizures. Neurologia 2023; 38:647-652. [PMID: 37858895 DOI: 10.1016/j.nrleng.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHODS We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72 hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P = .25) or with the risk of recurrence within 6 months (P = .63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Quintana
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Fonseca
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Abraira
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Toledo
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Santamarina
- Unidad de Epilepsia, Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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Villanueva V, Rodriguez-Osorio X, Juiz-Fernández Á, Sayas D, Hampel K, Castillo A, Montoya J, Garcés M, Campos D, Rubio-Nazábal E, Fernández-Cabrera A, Gifreu A, Santamarina E, Hernández Pérez G, Falip M, Parejo-Carbonell B, García-Morales I, Martínez AB, Massot M, Asensio M, Giménez J, Guillén V, Ruiz-Giménez J, Chavarria B, Rocamora R, Escalza I. Real-life evidence about the use of intravenous brivaracetam in urgent seizures: The BRIV-IV study. Epilepsy Behav 2023; 147:109384. [PMID: 37634373 DOI: 10.1016/j.yebeh.2023.109384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE Urgent seizures are a medical emergency for which new therapies are still needed. This study evaluated the use of intravenous brivaracetam (IV-BRV) in an emergency setting in clinical practice. METHODS BRIV-IV was a retrospective, multicenter, observational study. It included patients ≥18 years old who were diagnosed with urgent seizures (including status epilepticus (SE), acute repetitive seizures, and high-risk seizures) and who were treated with IV-BRV according to clinical practice in 14 hospital centers. Information was extracted from clinical charts and included in an electronic database. Primary effectiveness endpoints included the rate of IV-BRV responder patients, the rate of patients with a sustained response without seizure relapse in 12 h, and the time between IV-BRV administration and clinical response. Primary safety endpoints were comprised the percentage of patients with adverse events and those with adverse events leading to discontinuation. RESULTS A total of 156 patients were included in this study. The mean age was 57.7 ± 21.5 years old with a prior diagnosis of epilepsy for 57.1% of patients. The most frequent etiologies were brain tumor-related (18.1%) and vascular (11.2%) epilepsy. SE was diagnosed in 55.3% of patients. The median time from urgent seizure onset to IV treatment administration was 60.0 min (range: 15.0-360.0), and the median time from IV treatment to IV-BRV was 90.0 min (range: 30.0-2400.0). Regarding dosage, the mean bolus infusion was 163.0 ± 73.0 mg and the mean daily dosage was 195.0 ± 87.0 mg. A total of 77.6% of patients responded to IV-BRV (66.3% with SE vs. 91% other urgent seizures) with a median response time of 30.0 min (range: 10.0-60.0). A sustained response was achieved in 62.8% of patients. However, adverse events were reported in 14.7%, which were predominantly somnolence and fatigue, with 4.5% leading to discontinuation. Eighty-six percent of patients were discharged with oral brivaracetam. CONCLUSION IV-BRV in emergency settings was effective, and tolerability was good for most patients. However, a larger series is needed to confirm the outcomes.
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Affiliation(s)
- Vicente Villanueva
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | | | - Debora Sayas
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Kevin Hampel
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Javier Montoya
- Consorcio Hospital General Universitario, Valencia, Spain
| | - Mercedes Garcés
- Member of ERN EPICARE, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Dulce Campos
- Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | | | | | | | | | | | - Mercé Falip
- Hospital Universitario Bellvitge, Barcelona, Spain
| | | | | | | | | | | | - Juana Giménez
- Hospital General Universitario Dr Balmis, Alicante, Spain
| | - Virginia Guillén
- Hospital General Universitario Virgen de las Nieves, Granada, Spain
| | | | - Beatriz Chavarria
- Member of ERN EPICARE, Hospital Universitario del Mar, Barcelona, Spain
| | - Rodrigo Rocamora
- Member of ERN EPICARE, Hospital Universitario del Mar, Barcelona, Spain
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Gajate-García V, Gutiérrez-Viedma Á, Romeral-Jiménez M, Serrano-García I, Parejo-Carbonell B, Montalvo-Moraleda T, Valls-Carbó A, García-Morales I. Seizures in the Emergency Department: clinical and diagnostic data from a series of 153 patients. Neurologia 2023; 38:29-34. [PMID: 34836845 DOI: 10.1016/j.nrleng.2020.02.011] [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: 10/14/2019] [Accepted: 02/08/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P < .001) and with history of refractory epilepsy (P = .002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P = .049) and status epilepticus (P = .018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was 0.45 (diagnosis was modified in 20% of patients). CONCLUSIONS Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.
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Affiliation(s)
- V Gajate-García
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Á Gutiérrez-Viedma
- Servicio de Neurología, Hospital Fundación Jiménez Díaz, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD), Madrid, Spain.
| | - M Romeral-Jiménez
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - I Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | - B Parejo-Carbonell
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
| | - T Montalvo-Moraleda
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - A Valls-Carbó
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - I García-Morales
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, Spain
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Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography. J Neurol 2022; 269:3761-3769. [PMID: 35152335 PMCID: PMC8852852 DOI: 10.1007/s00415-022-11005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 12/02/2022]
Abstract
Background Diagnosis of epileptic seizures, particularly regarding status epilepticus (SE), may be challenging in an emergency room setting. The aim of the study was to study the diagnostic yield of perfusion computed tomography (pCT) in patients with single epileptic seizures and SE. Methods We retrospectively reviewed the records of patients who followed an acute ischemic stroke pathway during a 9-month period and who were finally diagnosed with a single epileptic seizure or SE. Perfusion maps were visually analyzed for the presence of hyperperfusion and hypoperfusion. Clinical data, EEG patterns, and neuroimaging findings were compared. Results We included 47 patients: 20 (42.5%) with SE and 27 (57.5%) with single epileptic seizure. Of 18 patients who showed hyperperfusion on pCT, 12 were ultimately diagnosed with SE and eight had EEG findings compatible with an SE pattern. Focal hyperperfusion on pCT had a sensitivity of 60% (95% CI 36.4–80.2) and a specificity of 77.8% (95% CI 57.2–90.6) for predicting a final diagnosis of SE. The presence of cerebral cortical and thalamic hyperperfusion had a high specificity for predicting SE presence. Of note, 96% of patients without hyperperfusion on pCT did not show an SE pattern on early EEG. Conclusions In acute settings, detection by visual analysis of focal cerebral cortical hyperperfusion on pCT in patients with epileptic seizures, especially if accompanied by the highly specific feature of thalamic hyperperfusion, is suggestive of a diagnosis of SE and requires clinical and EEG confirmation. The absence of focal hyperperfusion makes a diagnosis of SE unlikely.
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Fernández Alonso C, González Martínez F, Alonso Avilés R, Liñán López M, Fuentes Ferrer ME, Gros Bañeres B. Risk model of seizure cluster or status epilepticus and intervention in the emergency department. Neurologia 2021; 39:S0213-4853(21)00079-7. [PMID: 34053811 DOI: 10.1016/j.nrl.2021.02.015] [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: 12/16/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify possible predictors of seizure cluster or status epilepticus (SE) and to evaluate whether these patients receive greater interventions in emergency departments. METHODOLOGY We conducted a secondary analysis of the ACESUR Registry, a multipurpose, observational, prospective, multicentre registry of adult patients with seizures from 18 emergency departments. Clinical and care-related variables were collected. We identified risk factors and risk models for seizure cluster or SE and assessed the effect of interventions by prehospital emergency services and the hospital emergency department. RESULTS We identified a total of 186 (28%) patients from the ACESUR registry with seizure cluster (126 [19%]) or SE (60 [9%]); the remaining 478 patients (72%) had isolated seizures. The risk model for seizure cluster or SE in the emergency department included Charlson Comorbidity Index scores≥3 (OR: 1.60; 95% CI, 1.05-2.46; P=.030), ≥2 habitual antiepileptic drugs (OR: 2.29; 95% CI, 1.49-3.51; P<.001), and focal seizures (OR: 1.56; 95% CI, 1.05-2.32; P=.027). The area under the curve of the model was 0.735 (95% CI, 0.693-0.777; P=.021). Patients with seizure cluster and SE received more aggressive interventions both by prehospital emergency services (OR: 2.89; 95% CI, 1.91-4.36; P<.001) and at the emergency department (OR: 4.41; 95% CI, 2.69-7.22; P<.001). CONCLUSIONS This risk model may be of prognostic value in identifying adult patients at risk of presenting seizure cluster or SE in the emergency department. In our sample, these patients received more aggressive treatment than adult patients with isolated seizures before arriving at hospital, and even more so in the emergency department.
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Affiliation(s)
| | | | - R Alonso Avilés
- Hospital Universitario Clínico de Valladolid, Valladolid, España
| | - M Liñán López
- Hospital Neurotraumatológico Virgen de las Nieves de Granada, Granada, España
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Llauradó A, Quintana M, Fonseca E, Abraira L, Toledo M, Requena M, Olivé M, Ballvé A, Campos D, Sueiras M, Santamarina E. Implications of initiating antiseizure drugs prior to the performance of EEG in first epileptic seizures. Neurologia 2021; 38:S0213-4853(21)00053-0. [PMID: 33875301 DOI: 10.1016/j.nrl.2021.02.014] [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: 12/22/2020] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aimed to determine whether the administration of antiepileptic drugs (AED) alters the likelihood of detecting epileptiform abnormalities in electroencephalographies (EEG) performed early after a first epileptic seizure. METHOD We performed a retrospective, observational study including patients with a first seizure attended at our centre's emergency department between July 2014 and November 2019. We collected clinical data, as well as technical data on the acquisition and interpretation of the EEG performed within the first 72hours after the seizure, and the factors related with seizure recurrence. RESULTS We recruited 155 patients with a mean (SD) age of 48.6 (22.5) years; 61.3% were men. Regarding seizure type, 51% presented tonic-clonic seizures of unknown onset and 12% presented focal to bilateral tonic-clonic seizures. Thirty-nine patients (25.2%) received AED treatment before the EEG was performed: 33 received a non-benzodiazepine AED and 6 received a benzodiazepine. Epileptiform abnormalities were observed in 29.7% of patients. Previous administration of AEDs was not significantly associated with the probability of detecting interictal epileptiform abnormalities (P=.25) or with the risk of recurrence within 6 months (P=.63). CONCLUSIONS Administration of AEDs before an early EEG following a first seizure does not decrease the likelihood of detecting epileptiform abnormalities. These findings suggest that starting AED treatment immediately in patients with a high risk of early recurrence does not imply a reduction in the diagnostic accuracy of the test.
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Affiliation(s)
- A Llauradó
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Quintana
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Fonseca
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - L Abraira
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Toledo
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Requena
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Olivé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - A Ballvé
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - D Campos
- Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - M Sueiras
- Servicio, de Neurofisiología Clínica, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Santamarina
- Unidad de Epilepsia; Servicio de Neurología, Hospital Universitari Vall d'Hebron, Barcelona, España.
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Llauradó A, Quintana M, Ballvé A, Campos D, Fonseca E, Abraira L, Toledo M, Santamarina E. Factors associated with resistance to benzodiazepines in status epilepticus. J Neurol Sci 2021; 423:117368. [PMID: 33652289 DOI: 10.1016/j.jns.2021.117368] [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: 11/05/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode. METHODS All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed. RESULTS Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001). SIGNIFICANCE The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
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Affiliation(s)
- Arnau Llauradó
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Quintana
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Alejandro Ballvé
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Daniel Campos
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Elena Fonseca
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Laura Abraira
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Manuel Toledo
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain
| | - Estevo Santamarina
- Epilepsy Unit, Neurology Department, Vall de Hebron University Hospital, Barcelona, Spain.
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Gajate-García V, Gutiérrez-Viedma Á, Romeral-Jiménez M, Serrano-García I, Parejo-Carbonell B, Montalvo-Moraleda T, Valls-Carbó A, García-Morales I. Seizures in the Emergency Department: Clinical and diagnostic data from a series of 153 patients. Neurologia 2020; 38:S0213-4853(20)30047-5. [PMID: 32565035 DOI: 10.1016/j.nrl.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/25/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Seizures are a frequent reason for admission to emergency departments and require early, precise diagnosis and treatment. The objective of this study was to describe the clinical and prognostic characteristics of a series of patients with seizures attended at our hospital's emergency department. METHODS We performed a retrospective, observational study of all patients with seizures who were admitted to our hospital's emergency department and attended by the on-call neurology service between February and August 2017. RESULTS We included 153 patients, representing 9.9% of all neurological emergency department admissions. The median age was 58 years, 52.3% of patients were women, and 51% had history of epilepsy. Onset was focal in 82.4% of cases, and the most frequent aetiology was cerebrovascular disease (24.2%). Twelve patients (7.8%) developed status epilepticus, which was associated with higher scores on the ADAN scale (P<.001) and with history of refractory epilepsy (P=.002). The in-hospital mortality rate was 3.7%, and in-hospital mortality was associated with older age (P=.049) and status epilepticus (P=.018). Eighty percent of patients with no history of epilepsy were diagnosed with epilepsy at the emergency department; all started treatment. The kappa coefficient for epilepsy diagnosis in the emergency department compared to diagnosis after one year of follow-up by the epilepsy unit was .45 (diagnosis was modified in 20% of patients). CONCLUSIONS Seizures are a frequent neurological emergency with potential complications and considerable morbidity and mortality rates. In patients with no known history of epilepsy, the condition may be diagnosed in the emergency department, but follow-up at specialised epilepsy units is recommended.
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Affiliation(s)
- V Gajate-García
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Á Gutiérrez-Viedma
- Servicio de Neurología, Hospital Fundación Jiménez Díaz, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz (iiSFJD), Madrid, España.
| | - M Romeral-Jiménez
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - I Serrano-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Unidad de Metodología de Investigación y Epidemiología Clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, España
| | - B Parejo-Carbonell
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - T Montalvo-Moraleda
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - A Valls-Carbó
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - I García-Morales
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España; Unidad de Epilepsia, Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
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Tuppurainen KM, Ritvanen JG, Mustonen H, Kämppi LS. Predictors of mortality at one year after generalized convulsive status epilepticus. Epilepsy Behav 2019; 101:106411. [PMID: 31668580 DOI: 10.1016/j.yebeh.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Status epilepticus (SE) is a life-threatening neurologic emergency, which requires prompt medical treatment. Little is known of the long-term survival of SE. The aim of this study was to investigate which factors influence 90 days and 1-year mortality after SE. MATERIALS AND METHODS This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with generalized convulsive SE (GCSE) in Helsinki University Central Hospital (HUCH) emergency department (ED) over 2 years. We defined specific factors including patient demographics, GCSE characteristics, treatment, complications, delays in treatment, and outcome at hospital discharge and determined their relation to 90 days and 1-year mortality after GCSE by using logistic regression models. Survival analyses at 1 year after GCSE were performed with Cox proportional hazards regression analysis. RESULTS In-hospital mortality was 7.1%. Mortality rate was 14.3% at 90 days and 24.3% at 1 year after GCSE. In the univariate logistic regression analysis, Status Epilepticus Severity Score > 4 (STESS) (ODDS = 7.30, p = 0.012), worse-than-baseline condition at hospital discharge (ODDS = 3.5, p = 0.006), long delays in attaining seizure freedom (ODDS = 2.2, p = 0.041), and consciousness (ODDS = 3.4, p = 0.014) were risk factors for mortality at 90 days whereas epilepsy (ODDS = 0.2, p = 0.014) and Glasgow Outcome Scale (GOS) >3 at hospital discharge (ODDS = 0.05, p = 0.006) were protective factors. Risk factors for mortality at 1 year were STESS >4 (ODDS = 5.1, p = 0.028), use of vasopressors (ODDS = 8.2, p = 0.049), and worse-than-baseline condition at discharge (ODDS = 7.8, p = 0.010) while GOS >3 (ODDS = 0.2, p = 0.005) was protective. The univariate survival analysis at 1 year confirmed the significant findings regarding parameters STESS >4 (Hazard ratio (HR) = 4.1, p = 0.009), worse-than-baseline condition (HR = 6.2, p = 0.015), GOS >3 (HR = 0.2, p = 0.004) at hospital discharge and epilepsy (HR = 0.4, p = 0.044). Additionally, diagnostic delay over 6 h (HR = 3.8, p = 0.022) and Complication Burden Index (CBI) as an ordinal variable (0-2, 3-6, >6) (HR = 2.7, p = 0.027) were predictive for mortality. In the multivariate survival analysis, STESS > 4 (HR = 5.1, p = 0.007), CBI (HR = 3.2, p = 0.025, ordinal variable), diagnostic delay over 6 h (HR = 7.2, p = 0.003), and worse-than-baseline condition at hospital discharge (HR = 5.8, p = 0.027) were all independent risk factors for mortality at 1 year. CONCLUSIONS Severe form of SE, delayed recognition of GCSE, high number of complications during treatment period, and poor condition at hospital discharge are all independent predictors of long-term mortality. Most of these factors are also associated with mortality at 90 days, though at that point, delays in treatment seem to have a greater impact on prognosis than at 1 year. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
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Affiliation(s)
- Kati Marjatta Tuppurainen
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
| | - Jaakko Gabriel Ritvanen
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
| | - Leena Sinikka Kämppi
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
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