Abstracts

Rationale: Status epilepticus (SE) is a life-threatening emergency. The physiologic changes associated with SE contribute to enhanced seizure pharmacoresistance, and have been demonstrated to occur as early as 30 minutes from SE onset. This suggests that sustained seizures would be less refractory with earlier treatment of SE, as receptor and neurotransmitter changes would have yet to fully develop. The literature, however, remains limited and conflicting regarding how time to initial treatment of SE (TTSE) affects outcome. To further elucidate this relationship, the aim of this study was to determine whether shorter TTSE is associated with better outcome at hospital discharge.Methods: We conducted a retrospective analysis of all patients diagnosed with SE at a university hospital from 1/1/05-10/31/12. The cohort was analyzed using 4 cut-off times for TTSE, as measured in minutes: TTSE 10 vs. >10; 30 vs. >30; 60 vs. >60; and 120 vs. >120. The primary outcome measure was good outcome at hospital discharge, defined as a modified Rankin scale score (mRS) of 0-2. Secondary outcomes included duration of SE, days hospitalized, days in the ICU and total number of antiepileptic drugs (AEDs) used prior to termination of SE. Statistical analysis accounted for non-normally distributed data. Logistic regression was performed for categorical data. Continuous nonparametric data was analyzed using the Mann-Whitney U test. Significance was set at p=0.05.Results: Of the 157 cases of SE identified, TTSE could be obtained from 151 cases, such that the cohort consisted of 151 cases of SE drawn from 148 patients. Mean age was 59 years, and 45% (N=68) were male. The TTSE was 10 minutes in 16.6% (N=25); 30 minutes in 35.8% (N=54); 60 minutes in 51.7% (N=78); and 120 minutes in 67.5% (N=102). On logistic regression analysis, TTSE 30 and 60 minutes was significantly associated with good outcome (p=0.04, CI 1.05-5.84 and p=0.05, CI 0.98-6.02). When co-varying for age, gender and etiology of SE (cardiac arrest vs. non-cardiac arrest), older age and cardiac arrest were associated with poor outcome at all time points. Shorter duration of SE and days in the ICU were significantly associated with TTSE 10 (p=0.001, p=0.05) and 30 minutes (p=0.02, p=0.03). There was no significant relationship between TTSE and days hospitalized or total number of AEDs used to achieve termination of SE.Conclusions: Shorter latency to initial treatment of status epilepticus is significantly associated with good outcome when initiated within 60 minutes of seizure onset, as measured by a mRS of 0-2. When age and seizure etiology are taken into account, older age and cardiac arrest are associated with poor outcome regardless of TTSE. A significant relationship also exists between shorter duration of SE and days spent in the ICU when SE is treated within 30 minutes of seizure onset. These findings suggest that older age and cardiac arrest confer poorer outcome, irrespective of TTSE. However, in younger cohorts, expeditious treatment of SE, particularly if initiated within a 30-60 minute window, is associated with better clinical outcome.