Intravenous anesthesia in treatment of nonconvulsive status epilepticus: Characteristics and outcomes.
OBJECTIVE
To determine factors associated with continuous anesthetic drug (IVAD) use in nonconvulsive status epilepticus (NCSE).


METHODS
Retrospective cohort study of patients who met clinical and EEG criteria of NCSE from 2009 to 2014 at a tertiary academic medical center. Patients were categorized according to IVAD use. Outcome variables were response to treatment and in-hospital death. We used descriptive analyses for baseline characteristics and outcome variable differences among patients who did and did not receive IVAD.


RESULTS
Forty-three patients had a total of 45 NCSE episodes. IVAD was used in 69% of the episodes. Patients treated with IVAD were younger (53.1 ± 14.1 vs 64.1 ± 13.3, p = 0.019). The episodes treated with IVAD occurred more frequently in patients with an acute neurologic pathology (58% vs 21%, p = 0.024) and those presenting in a coma (39% vs 7%, p = 0.030). NCSE resolved in 74% of the patients who received IVAD. Duration of NCSE did not differ significantly by treatment group. There were total 13 in-hospital deaths: ten in IVAD users vs three in the no-IVAD group (p > 0.05). Only one in-hospital death appeared to be a direct consequence of IVAD use. Mortality was more common among episodes that were not treated according to the published status epilepticus treatment guidelines compared to the episodes where guidelines were followed.


CONCLUSIONS
Our findings showed that factors such as younger age, acute neurologic pathology and coma at presentation were associated with IVAD use in patients with NCSE. These factors should be controlled in the future outcome and effectiveness studies to determine the effect of IVAD use on outcome of NCSE.
Department of Neurology, Comprehensive Epilepsy Center, University of Kansas Medical Center, 3901 Rainbow Blvd Mailstop 1065, Kansas City, KS 66160, USA. Electronic address: uuysal@kumc.edu.
Utku
U
Uysal
University of Virginia Department of Neurology, FE Dreifuss Comprehensive Epilepsy Program, PO Box 800394, Charlottesville, VA 22908, USA. Electronic address: quigg@virginia.edu.
Mark
M
Quigg
Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd. Mailstop 2012, Kansas City, KS 66160, USA. Electronic address: bbittel@kumc.edu.
Brennen
B
Bittel
Department of Neurology, Comprehensive Epilepsy Center, University of Kansas Medical Center, 3901 Rainbow Blvd Mailstop 1065, Kansas City, KS 66160, USA. Electronic address: nhammond@kumc.edu.
Nancy
N
Hammond
University of Kansas School of Medicine, Department of Preventive Medicine and Public Health, 3901 Rainbow Blvd. Mail Stop 1008, Kansas City, KS 66160, USA. Electronic address: tshireman@kumc.edu.
Theresa I
TI
Shireman
D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D004829:Epilepsy, Generalized / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants
Anesthetic drugs; Antiepileptic drugs; Benzodiazepines; Nonconvulsive status epilepticus; Refractory status epilepticus