Abstracts

Rationale: Status epilepticus (SE) is neurological emergency had a high overall mortality rate up to 38%. There only few studies investigated the association of phenytoin (PHT), valproate (VPA), and levetiracetam (LEV) with liver or renal diseases, or compared their efficacy in the treatment of SE. This study was to report the doctors' choice of 3 intravenous(IV) antiepilepticus drugs (AEDs) during the course of SE management based on the drug efficacy and AED related adverse events.. Methods: This retrospective study included all patients admitted to the ICU of Chang Gung Memorial Hospital for the treatment of SE in 2014. All patients received intravenous (IV) antiepileptic drugs (AEDs: PHT, VPA, or LEV), and were classified into three groups: continuing the initial AED, shifting to another AED, and adding another AED. Demographic data, clinical seizure features, consciousness, causes of SE, course of AEDs, complete laboratory data, results of electroencephalography and imaging studies, and clinical outcomes were collected. Results: A total of 67 patients (52.2% male) were included in this study, and their demographic and clinical characteristics are summarized in Table 1.For each IV AED, the patient number and the results of treatment for the 3 treatment groups are summarized in Table 2. Each IV AED was used in about one third of SE episodes. VPA had the lowest inadequate SE control rate compared to LEV (p=0.010) and PHT (p=0.011), and LEV had fewer adverse events than the other two AEDs. The mortality rate of the three AED groups was similar (p=0.629) on transfer from the ICU, and the most common cause was an underlying disease. The adverse effect of abnormal liver function was the major reason for shifting to another AED in PHT and VPA groups. Conclusions: This study suggests that adequate usage of IV AEDs resulted successful seizure control in most of the SE patients and the preference of initial AEDs selection was about the same for the 3 IV AEDs. Significant portion patients using initial VPA were changed to another AED due to adverse events. All of the patients receiving initial IV LEV continued to use LEV; on the other hand, another AED was added in 55.6 % of initial IV LEV patients due to insufficient drug efficacy. Choice of VPA as the initial AED had favorable SE control than PHT. The IV LEV had fewer adverse events than the other two ADEs. The mortality of patients having SE was related to the cause of SE. Funding: None