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Treatment deviating from guidelines does not influence status epilepticus prognosis

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Abstract

Status epilepticus (SE) prognosis is related to nonmodifiable factors (age, etiology), but the exact role of drug treatment is unclear. This study was undertaken to address the prognostic role of treatment adherence to guidelines (TAG). We prospectively studied over 26 months a cohort of adults with incident SE (excluding postanoxic). TAG was assessed in terms of drug doses (±30 % of recommendations) and medication sequence; its prognostic impact on mortality and return to baseline conditions was adjusted for etiology, SE severity [Status Epilepticus Severity Score (STESS)], and comorbidities. Of 225 patients, 26 (12 %) died and 82 (36 %) were discharged with a new handicap; TAG was observed in 142 (63 %). On univariate analysis, age, etiology, SE severity, and comorbidities were significantly related to outcome, while TAG was associated with neither outcome nor likelihood of SE control. Logistic regression for mortality identified etiology [odds ratio (OR) 18.8, 95 % confidence interval (CI) 4.3–82.8] and SE severity (STESS ≥3; OR 1.7, 95 % CI 1.2–2.4) as independent predictors, and for lack of return to baseline, again etiology (OR 7.4, 95 % CI 3.9–14.0) and STESS ≥3 (OR 1.7, 95 % CI 1.4–2.2). Similar results were found for the subgroup of 116 patients with generalized-convulsive SE. Receiver operator characteristic (ROC) analyses confirmed that TAG did not improve outcome prediction. This study of a large SE cohort suggests that treatment adherence to recommendations using current medications seems to play a negligible prognostic role (class III), confirming the importance of the biological background. Awaiting further treatment trials, it appears mandatory to apply resources towards identification of new therapeutic approaches.

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Conflicts of interest

A.O.R. received research grants from Pfizer, UCB, GSK, and Sandoz. All other authors do not have anything to disclose.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Service de Neurologie, CHUV, BH-07, 1011, Lausanne, Switzerland

    Andrea O. Rossetti

  2. Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Andrea O. Rossetti & Vincent Alvarez

  3. Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Jean-Marie Januel & Bernard Burnand

Authors
  1. Andrea O. Rossetti
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  2. Vincent Alvarez
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  3. Jean-Marie Januel
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  4. Bernard Burnand
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Correspondence to Andrea O. Rossetti.

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Rossetti, A.O., Alvarez, V., Januel, JM. et al. Treatment deviating from guidelines does not influence status epilepticus prognosis. J Neurol 260, 421–428 (2013). https://doi.org/10.1007/s00415-012-6644-x

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  • DOI: https://doi.org/10.1007/s00415-012-6644-x

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