Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study.

Autor: Herzig-Nichtweiß J; Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany., Salih F; Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany., Berning S; Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany., Malter MP; Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany., Pelz JO; Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany., Lochner P; Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany., Wittstock M; Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany., Günther A; Department of Neurology, University Hospital Jena, Jena, Germany., Alonso A; Department of Neurology, Medical Faculty Mannheim, Ruprecht Karl University of Heidelberg, Mannheim, Germany., Fuhrer H; Department of Neurology, University Hospital Freiburg, Freiburg, Germany., Schönenberger S; Department of Neurology, Medical Faculty Heidelberg, Ruprecht Karl University of Heidelberg, Heidelberg, Germany., Petersen M; Department of Neurology, Klinikum Osnabrück, Osnabrück, Germany., Kohle F; Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany., Müller A; Department and Policlinic of Neurology, Leipzig University Medicine, Leipzig, Germany., Gawlitza A; Department of Neurology, Medical Faculty, Saarland University Medical Center, Homburg a. d. Saar, Germany., Gubarev W; Department and Policlinic of Neurology, Rostock University Medical Center, Rostock, Germany., Holtkamp M; Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany., Vorderwülbecke BJ; Epilepsy-Center Berlin-Brandenburg, Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Charitéplatz 1, 10117, Germany. bernd.vorderwuelbecke@charite.de.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 Sep 15; Vol. 13 (1), pp. 85. Date of Electronic Publication: 2023 Sep 15.
DOI: 10.1186/s13613-023-01183-0
Abstrakt: Background: Acute symptomatic epileptic seizures are frequently seen in neurocritical care. To prevent subsequent unprovoked seizures, long-term treatments with antiseizure medications are often initiated although supporting evidence is lacking. This study aimed at prospectively assessing the risk of unprovoked seizure relapse with respect to the use of antiseizure medications. It was hypothesized that after a first acute symptomatic seizure of structural etiology, the cumulative 12-month risk of unprovoked seizure relapse is ≤ 25%.
Methods: Inclusion criteria were age ≥ 18 and acute symptomatic first-ever epileptic seizure; patients with status epilepticus were excluded. Using telephone and mail interviews, participants were followed for 12 months after the acute symptomatic first seizure. Primary endpoint was the occurrence and timing of a first unprovoked seizure relapse. In addition, neuro-intensivists in Germany were interviewed about their antiseizure treatment strategies through an anonymous online survey.
Results: Eleven of 122 participants with structural etiology had an unprovoked seizure relapse, resulting in a cumulative 12-month risk of 10.7% (95%CI, 4.7%-16.7%). None of 19 participants with a non-structural etiology had a subsequent unprovoked seizure. Compared to structural etiology alone, combined infectious and structural etiology was independently associated with unprovoked seizure relapse (OR 11.1; 95%CI, 1.8-69.7). Median duration of antiseizure treatment was 3.4 months (IQR 0-9.3). Seven out of 11 participants had their unprovoked seizure relapse while taking antiseizure medication; longer treatment durations were not associated with decreased risk of unprovoked seizure relapse. Following the non-representative online survey, most neuro-intensivists consider 3 months or less of antiseizure medication to be adequate.
Conclusions: Even in case of structural etiology, acute symptomatic seizures bear a low risk of subsequent unprovoked seizures. There is still no evidence favoring long-term treatments with antiseizure medications. Hence, individual constellations with an increased risk of unprovoked seizure relapse should be identified, such as central nervous system infections causing structural brain damage. However, in the absence of high-risk features, antiseizure medications should be discontinued early to avoid overtreatment.
(© 2023. La Société de Réanimation de Langue Francaise = The French Society of Intensive Care (SRLF).)
Databáze: MEDLINE
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