Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice.
OBJECTIVE
Generalized convulsive status epilepticus (GCSE) needs immediate management. Despite guidelines, adherence to management protocols is often poor, this contributing to poor outcome. We aimed to evaluate the usefulness of a management protocol in GCSE.


METHODS
This is a prospective population-based study of consecutive adults with GCSE in Haute-Garonne district, France. Demographics and treatment procedures were documented. Factors associated with seizure termination and refractoriness were analyzed using logistic regression.


RESULTS
One hundred eighteen episodes in 111 adults (mean age 55 years) between October 2006 and February 2008 were included. SE was convulsive in 101 episodes. Incidence was 6.6 per 100,000 and case fatality was 9%. Adequate initial treatment according to protocol was observed in 38%; 64% were treated out-of-hospital, and SE was refractory in 27% [no response after two antiepileptic drugs (AED)]. Patients who received adequate first-line treatment were 6.8 times [95% confidence interval (CI) 2.8-16.9] more likely to have seizure termination, with 74% versus 29% efficacy rate (p < 0.0001). Inadequate initial management was 4.7 times (1.9-11.1) more likely to need several benzodiazepine doses (p = 0.0004) and 9.1 times (3.7-20) more likely to require a long-acting AED as next treatment (p < 0.0001). Seizure termination after initial treatment was associated with decreased intensive care unit stay [1 (1-2) versus 2 (1-5.5) days, p < 0.0001] and hospital stay [3 (2-11) versus 7 (3-18) days, p = 0.009].


CONCLUSIONS
GCSE termination and outcome seem clearly associated with adherence to treatment protocol. Results add to the debate on appropriate allocation of resources for out-of-hospital treatment, licensed drugs, and achievement of guideline implementation to improve SE outcome.
Aranda
Alexandre
A
Service de Neurologie, Hôpital Rangueil, CHU Toulouse, France.
Foucart
Guillaume
G
Ducassé
Jean Louis
JL
Grolleau
Sabrina
S
McGonigal
Aileen
A
Valton
Luc
L
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols / Q000592:standards; D015331:Cohort Studies; D004351:Drug Resistance; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D000927:Anticonvulsants