Background Status epilepticus (SE) is a life-threatening situation, which urges prompt antiepileptic treatment and intensive care. In the past few years, newer types of antiepileptic drugs (AEDs) have become available for SE treatment as second- or third-line drugs. AEDs should be prescribed for patients surviving SE as maintenance therapy in order to prevent further seizures.
Purpose To assess the prescription pattern of older and newer types of AEDs and their probable influence on the outcome of treatment (mortality and seizure freedom) after SE.
Material and methods Patients’ data were retrieved from patients’ files covering the period 1 January 2013 to 31 December 2017 in a retrospective study of patients who were treated and coded with SE diagnoses in accordance with the International Classification of Diseases by the WHO at the neurointensive unit of a tertiary teaching hospital. The end of follow-up was 30 June 2018.
Results In total 135 episodes (male: 68, 50.4%) were evaluated. The mean age was 64.1±13.9 years. The mean follow-up time was 39.9±14.2 months. Patients who survived SE (101 patients) took one (48.5%), two (36.6%) and three or more (14.9%) AEDs (49, 37 and 15 patients, respectively) at discharge to maintain freedom from seizures. The most common prescribed older type AEDs were carbamazepine and valproate. The prescriptions of newer type AEDs (60.3%; e.g. levetiracetam, oxcarbazepine, lamotrigine and lacosamide) were significantly higher at discharge than at admission (p<0.005). The mean seizure-free period was 6.8±6.9 months (the shortest seizure-free time was 1 day and the longest one was 5 years). In the case of patients taking carbamazepine (20.9%; OR: 0.37, 95% CI: 0.16 to 0.82; p=0.018), levetiracetam (27.5%; OR: 0.51, 95% CI: 0.27 to 0.97; p=0.041) or valproate (11.1%; OR: 0.18, 95% CI: 0.05 to 0.61; p=0.0043) had the highest probability of achieving seizure freedom among our patients. The choice of AED at discharge had no significant effect on mortality. Twenty-five patients had no seizure until the end of this study. Thirty-one patients (30.7%) died after the discharge period primarily due to co-morbidities.
Conclusion The administration of newer type AEDs in SE treatment may have an impact on the prescription pattern after discharge, however older type AEDs (carbamazepine, valproate) are a reasonable choice in achieving seizure freedom after SE.
References and/or acknowledgements N/A.
No conflict of interest.
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