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Loddenkemper T. Detect, predict, and prevent acute seizures and status epilepticus. Epilepsy Behav 2023; 141:109141. [PMID: 36871317 DOI: 10.1016/j.yebeh.2023.109141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
Status epilepticus is one of the most frequent pediatric neurological emergencies. While etiology is often influencing the outcome, more easily modifiable risk factors of outcome include detection of prolonged convulsive seizures and status epilepticus and appropriately dosed and timely applied medication treatment. Unpredictability and delayed or incomplete treatment may at times lead to longer seizures, thereby affecting outcomes. Barriers in the care of acute seizures and status epilepticus include the identification of patients at greatest risk of convulsive status epilepticus, potential stigma, distrust, and uncertainties in acute seizure care, including caregivers, physicians, and patients. Furthermore, unpredictability, detection capability, and identification of acute seizures and status epilepticus, limitations in access to obtaining and maintaining appropriate treatment, and rescue treatment options pose challenges. Additionally, timing and dosing of treatment and related acute management algorithms, potential variations in care due to healthcare and physician culture and preference, and factors related to access, equity, diversity, and inclusion of care. We outline strategies for the identification of patients at risk of acute seizures and status epilepticus, improved status epilepticus detection and prediction, and acute closed-loop treatment and status epilepticus prevention. This paper was presented at the 8th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures held in September 2022.
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Affiliation(s)
- Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA 02115, USA.
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Sánchez Fernández I, Amengual-Gual M, Barcia Aguilar C, Gaínza-Lein M. Descriptive epidemiology and health resource utilization for status epilepticus in the emergency department in the United States of America. Seizure 2021; 87:7-16. [PMID: 33639504 DOI: 10.1016/j.seizure.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To describe the epidemiology and health resource utilization for convulsive status epilepticus (SE) in the emergency department (ED). METHODS Retrospective descriptive study in the Nationwide Emergency Department Sample (NEDS). Primary SE and secondary SE (SE in a case who visited the ED for other primary reason) were compared with non-SE seizures. Secondary SE is expected to have worse outcomes and higher costs because of another primary cause for ED visit. RESULTS In the period 2010-2014, there were 149,750 ED visits with primary SE; 83,459 ED with secondary SE; and 5,359,103 ED visits with non-SE seizures. On multivariable analysis adjusting for potential confounders, the odds of hospital admission were 7 times higher for primary SE than for non-SE seizures, and 5 times higher for secondary SE than for non-SE seizures; the odds of transfer to another hospital were 9 times higher for primary SE than for non-SE seizures, and 3 times higher for secondary SE than for non-SE seizures; the odds of death were 2.5 times higher for primary SE than for non-SE seizures, and 12 times higher for secondary SE than for non-SE seizures; and the charges (in January 2020 USA dollars) were $9000 higher in primary SE than in non-SE seizures, and $35,000 higher in secondary SE than in non-SE seizures. CONCLUSION Among all reasons for ED visits, SE, and in particular, secondary SE, are among the most resource-consuming conditions, being much more expensive than non-SE seizures in the ED.
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Affiliation(s)
| | - Marta Amengual-Gual
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Pediatric Neurology Unit, Department of Pediatrics, Hospital Universitari Son Espases, Universitat de les Illes Balears, Palma, Spain
| | - Cristina Barcia Aguilar
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Child Neurology, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marina Gaínza-Lein
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Instituto de Pediatría, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile; Servicio de Neuropsiquiatría Infantil. Hospital Clínico San Borja Arriarán, Universidad de Chile, Santiago, Chile
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Cornett EM, Amarasinghe SN, Angelette A, Abubakar T, Kaye AM, Kaye AD, Neuchat EE, Urits I, Viswanath O. VALTOCO ® (Diazepam Nasal Spray) for the Acute Treatment of Intermittent Stereotypic Episodes of Frequent Seizure Activity. Neurol Int 2021; 13:64-78. [PMID: 33670456 PMCID: PMC7931041 DOI: 10.3390/neurolint13010007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Valtoco® is a new FDA-approved nasal spray version of diazepam indicated for the treatment of acute, intermittent, and stereotypic episodes of frequent seizure activity in epilepsy patients six years of age and older. Although IV and rectal diazepam are already used to treat seizure clusters, Valtoco® has less variability in plasma concentration compared to rectal diazepam. Furthermore, the intranasal administration of Valtoco® is more convenient and less invasive than rectal or IV diazepam, making it ideal for self-administration outside of a hospital setting. Multiple clinical trials have taken place comparing Valtoco® to the oral, rectal, and IV forms of diazepam. Aside from mild nasal irritation and lacrimation, Valtoco® was found to have no increased safety risk in comparison to traditional forms of diazepam. This review of Valtoco® will include a history of diazepam prescribing and withdrawal treatment, Valtoco® drug information, its mechanism of action, pharmacokinetics and pharmacodynamics, and a comprehensive review of clinical studies.
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Affiliation(s)
- Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
| | - Sam N. Amarasinghe
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
| | - Alexis Angelette
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
| | - Tunde Abubakar
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, CA 95211, USA;
| | - Alan David Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
- LSU School of Medicine, LSUHSC New Orleans, New Orleans, LA 70112, USA
| | - Elisa E. Neuchat
- School of Medicine, Florida International University, Miami, FL 33199, USA;
| | - Ivan Urits
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Boston, MA 02215, USA
| | - Omar Viswanath
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA 71103, USA; (S.N.A.); (A.A.); (T.A.); (A.D.K.); (I.U.); (O.V.)
- Valley Anesthesiology and Pain Consultants–Envision Physician Services, Phoenix, AZ 85004, USA
- Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85724, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68124, USA
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