Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents.
BACKGROUND
Newer antiepileptic drugs (AEDs) are increasingly prescribed; however, relatively limited data are available regarding their use in status epilepticus (SE) and the impact on outcome.


OBJECTIVE
The aim of this study was to explore the evolution in prescription patterns of newer and traditional AEDs in this clinical setting, and their association with prognosis.


METHODS
We analyzed our prospective adult SE registry over a 10-year period (2007-2016) and assessed the yearly use of newer and traditional AEDs and their association with mortality, return to baseline conditions at discharge, and SE refractoriness, defined as treatment resistance to two AEDs, including benzodiazepines.


RESULTS
In 884 SE episodes, corresponding to 719 patients, the prescription of at least one newer AED increased from 0.38 per SE episode in 2007 to 1.24 per SE episode in 2016 (mostly due to the introduction of levetiracetam and lacosamide). Traditional AEDs (excluding benzodiazepines) decreased over time from 0.74 in 2007 to 0.41 in 2016, correlating with the decreasing use of phenytoin. The prescription of newer AEDs was independently associated with a lower chance of return to baseline conditions at discharge (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.40-0.84) and a higher rate of SE refractoriness (OR 19.84, 95% CI 12.76-30.84), but not with changes in mortality (OR 1.08, 95% CI 0.58-2.00).


CONCLUSIONS
We observed a growing trend in the prescription of newer AEDs in SE over the last decade; however, our findings might suggest an associated increased risk of SE refractoriness and new disability at hospital discharge. Pending prospective, comparative studies, this may justify some caution in the routine use of newer AEDs in SE.
Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland.
Isabelle
I
Beuchat
Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland.
Jan
J
Novy
Service de Neurologie, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), CHUV-BH07, and Lausanne University Hospital, 1011, Lausanne, Switzerland. andrea.rossetti@chuv.ch.
Andrea O
AO
Rossetti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D000927:Anticonvulsants