Efficacy of Home Anticonvulsant Administration for Second-Line Status Epilepticus Treatment
| Autor: | Rafael Wabl, Maria Kwok, Chloe E. Hill, Robert Silbergleit, Samuel W. Terman, James M. Chamberlain, Jordan J. Elm |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Comparative Effectiveness Research Drug Resistant Epilepsy medicine.medical_specialty Levetiracetam Adolescent medicine.medical_treatment Self Administration Status epilepticus Benzodiazepines Young Adult Status Epilepticus Double-Blind Method Internal medicine Outcome Assessment Health Care medicine Humans Child Adverse effect business.industry Valproic Acid Medical record Odds ratio Middle Aged Confidence interval Regimen Anticonvulsant Phenytoin Anticonvulsants Drug Therapy Combination Female Neurology (clinical) medicine.symptom business Research Article medicine.drug |
| Zdroj: | Neurology |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000012414 |
| Popis: | ObjectiveTo investigate whether receiving a second-line anticonvulsant medication that is part of a patient's home regimen influences outcomes in benzodiazepine-refractory convulsive status epilepticus.MethodsUsing the Established Status Epilepticus Treatment Trial data, allocation to a study drug included in the patient's home anticonvulsant medication regimen was compared to receipt of an alternative second-line study medication. The primary outcome was cessation of clinical seizures with improved consciousness by 60 minutes after study drug initiation. Secondary outcomes were seizure cessation adjudicated from medical records and adverse events. We performed inverse probability of treatment-weighted (IPTW) logistic regressions.ResultsOf 462 patients, 232 (50%) were taking 1–2 of the 3 study medications at home. The primary outcome was observed in 39/89 (44%) patients allocated to their home medication vs 76/143 (53%) allocated to a nonhome medication (IPTW odds ratio [OR] 0.66, 95% confidence interval [CI] 0.39–1.14). The adjudicated outcome occurred in 37/89 (42%) patients vs 82/143 (57%), respectively (IPTW OR 0.52, 95% CI 0.30–0.89). There was no interaction between study levetiracetam and home levetiracetam and there were no differences in adverse events.ConclusionThere was no difference in the primary outcome for patients who received a home medication vs nonhome medication. However, the retrospective evaluation suggested an association between receiving a nonhome medication and seizure cessation.Classification of EvidenceThis study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a nonhome anticonvulsant did not significantly affect the probability of stopping seizures. |
| Databáze: | OpenAIRE |
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