Abstracts

Rationale: Generalized Status Epilepticus (GSE) needs immediate diagnosis and treatment to prevent complications and death. Use of first efficient treatment should be the main goal of GSE management. Despite guidelines for diagnosis and treatment, inadequate applications of management protocol are frequent and may cause a loss of chance. Our goal was to study the usefulness of a program of evaluation of care procedures for GSE to improve diagnosis delay and prognosis, and increase treatment adequacy. Methods: We prospectively studied for consecutive patients with GSE in Toulouse (France). We noted used diagnosis criteria and treatment procedures, GSE characteristics and evolution. Results: At 16 months, 118 patients were included. GSE was confirmed in 113 patients and it was convulsive GSE in 101 cases. Mean age was 55 years, 32% were older than 65. Exclusions were four psychogenic SE, one posterior cerebral stroke. Convulsive GSE was diagnosed with seizure recurrence in 81% with mean of 3.77 seizures, and/or a single seizure in 24%, lasting more than 5 minutes with mean time of 20.4 minutes. Nine patients died (9%). 60% were known epileptic, 19% for prior status epilepticus. Mean length of stay was 3.8 days for intensive care unit and 10 days for overall hospitalization. A complication was found in 61%, ventilation assistance was required in 29%. EEG monitoring was performed in 41 patients with adherence to referential in 63% and demonstrated subtle status in 34%. Status epilepticus was considered refractory in 27% for no response after 2 antiepileptic drugs (AED), in 4% after 3 AED and in 28% at 60 minutes of treatment beginning. Therapeutic managements of CGSE were analyzed according to lines of treatment and adherence to referential. Effectiveness of first-line treatment was 47%. When it was in accordance with guideline (benzodiazepine and antiepileptic drug, mainly Fosphenytoin) in 40 patients, effectiveness was 75%, versus 30% when it was not (short action benzodiazepine alone) in 60 patients (p ≤0.0001). The failure of first-line treatment was linked to use of benzodiazepine alone, complications, refractory status, and increased length of stay (p ≤0.01). Adherence to referential was 40% for first-line treatment. Non appliance was linked to delayed use of AED, repetition of benzodiazepine, refractory status (p ≤0.01). Medical emergency management in France provided the possibility of out-of-hospital medicalized unit (SAMU). 64 patients (64%) were included and treated out-of-hospital, their status were over before arriving at the hospital in 83%. Conclusions: Our study confirms reassuring information on patients’ recruitment, mortality, aetiologies, as well as treatment management, as it has been observed in the main studies. In our study, effectiveness of first intention treatment depended on respect of care procedure in convulsive GSE (p ≤ 0.0001). In regard to our results, the improvement of practice especially for adherence to guidelines in management of GSE is the main achievement.