Abstracts

Rationale: Status epilepticus (SE) is defined as clinical or electrographic seizures  lasting greater than 5 minutes or recurrent seizures without returning to baseline between events. Refractory status epilepticus (RSE) is defined as continuous seizure activity that is not controlled by at least two anti-seizure medications (ASMs). Early treatment and termination of seizures in SE are important to reduce the risk of associated complications. Benzodiazepines are considered first line treatment for the management of SE. If patients continue to have seizures despite adequate trials of benzodiazepines, ASMs are initiated. Current guidelines recommend phenytoin/fosphenytoin, valproic acid, and levetiracetam as second line agents. The purpose of this retrospective chart review study is to evaluate the use and efficacy of ASMs for the treatment of SE in a veteran population with regards to time to resolution of SE and mortality.

Methods: A retrospective chart review was conducted within the VA Greater Los Angeles Healthcare System (VAGLAHS) from 1/1/2013 to 8/31/2018. Adult patients were eligible for inclusion if they were admitted to the medical center and had an electronic electroencephalogram (EEG) confirmed diagnosis or a clinical diagnosis of SE. Cases were identified via EEG consult service tracking list. To date, 694/1055 EEG reports have been reviewed and 42 cases of SE have been identified. Causes of SE, efficacy of ASMs used, and time to resolution of SE have been assessed. Descriptive statistics were used for all baseline demographic and laboratory data. Fisher’s exact test was used to analyze significance in primary outcomes with an α of 0.05 to determine significance.

Results: Preliminary analyses of 42 charts have been completed. The most common cause of SE in this cohort was anoxic/hypoxic injury, idiopathic etiologies, and ASM nonadherence. Forty patients (95%) received one dose of lorazepam as the initial benzodiazepine. More than half of the patients were not on any ASM medications prior to their episode of SE. The most common ASMs given after the benzodiazepine were  phenytoin/fosphenytoin (95%) and levetiracetam (88.1%). With regard to time to SE resolution, 38% of patients resolved in less than 24 hours, 35% of patients resolved between 24-48 hours, and 26% patients resolved in greater than 48 hours. Time to resolution of SE was less than 24 hours in 75% of the patients belonging to the ASM nonadherence group. When comparing time to resolution, there were no statistically significant differences between ASMs. RSE was reported in 38/42 (90%) patients. Nine patients died during their hospital admission.

Conclusions: SE is a medical and neurologic emergency, with outcomes that are often poor. Furthermore, until recently, optimal treatment approaches were not clearly defined. To better understand SE causes, treatment approaches, and associated outcomes, we reviewed 42 cases of SE treated at VAGLAHS over a period of 5 years. In our cohort there does not appear to be a statistically significant difference between ASMs with regard to time to resolution and mortality when used for the treatment of SE.

Funding: None