Forschungsdatenbank PMU-SQQUID

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Abstract

The treatment of refractory and super refractory status epilepticus is a "terra incognita" from the point of view of evidence-based medicine. As randomized or controlled studies that are sufficiently powered are not feasible in relation to the many therapies and treatment approaches available, we carried out an online multinational audit (registry) in which neurologists or intensivists caring for patients with status epilepticus may prospectively enter patients who required general anesthesia to control the status epilepticus (SE). To date, 488 cases from 44 different countries have been collected. Most of the patients had no history of epilepsy and had a cryptogenic etiology. First-line treatment was delayed and not in line with current guidelines. The most widely used anesthetic of first choice was midazolam (59%), followed by propofol and barbiturates. Ketamine was used in most severe cases. Other therapies were administered in 35% of the cases, mainly steroids and immunotherapy. Seizure control was achieved in 74% of the patients. Twenty-two percent of patients died during treatment, and four percent had treatment actively withdrawn because of an anticipated poor outcome. The neurological outcome was good in 36% and poor in 39.3% of cases, while 25% died during hospitalization. Factors that positively influenced outcome were younger age, history of epilepsy, and low number of different anesthetics tried. This article is part of a Special Issue entitled "Status Epilepticus".

Useful keywords (using NLM MeSH Indexing)

Adolescent

Adult

Age Factors

Aged

Aged, 80 and over

Anesthesia, General

Anesthetics, Dissociative/therapeutic use

Anesthetics, Intravenous/therapeutic use

Anticonvulsants/therapeutic use*

Barbiturates/therapeutic use

Child

Child, Preschool

Drug Resistant Epilepsy/complications

Drug Resistant Epilepsy/drug therapy*

Drug Resistant Epilepsy/mortality

Female

Guidelines as Topic

Health Care Surveys

Humans

Infant

Infant, Newborn

Ketamine/therapeutic use

Male

Medical Audit

Midazolam/therapeutic use

Middle Aged

Nervous System Diseases/etiology

Propofol/therapeutic use

Prospective Studies

Registries

Status Epilepticus/complications

Status Epilepticus/drug therapy*

Status Epilepticus/mortality

Treatment Outcome

Young Adult

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