Inadequate benzodiazepine dosing may result in progression to refractory and non-convulsive status epilepticus
| Autor: | Advait Mahulikar, Shishir Rao, Mohammad Ibrahim, Wazim Mohamed, Navid Seraji-Bozorgzad, Aashit Shah |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Drug Resistant Epilepsy medicine.drug_class Status epilepticus 030204 cardiovascular system & hematology Lorazepam Benzodiazepines 03 medical and health sciences Status Epilepticus 0302 clinical medicine Refractory Outcome Assessment Health Care medicine Humans Dosing Coma Aged Retrospective Studies Benzodiazepine business.industry Glasgow Outcome Scale Neurointensive care General Medicine Middle Aged Neurology Anesthesia Disease Progression Anticonvulsants Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Epileptic Disorders. 20:265-269 |
| ISSN: | 1950-6945 1294-9361 |
| DOI: | 10.1684/epd.2018.0987 |
| Popis: | Status epilepticus (SE) is defined as ongoing seizures lasting longer than five minutes or multiple seizures without recovery. Benzodiazepines (BZDs) are first-line agents for the management of SE. Our objective was to evaluate BZD dosing in SE patients and its effects on clinical/electrographic outcomes. A retrospective analysis was conducted from a prospective database of SE patients admitted to a university-based neurocritical care unit. The initial presentation and progression to refractory SE (RSE) and non-convulsive SE (NCSE) with coma was evaluated. Outcome measures included length of stay (LOS), rates of intubation, ventilator-dependent days, and Glasgow outcome scale (GOS). The lorazepam equivalent (LE) dosage of BZDs administered was calculated and we analysed variations in progression if 4 mg or more of LE (adequate BZDs) was administered. Among 100 patients, the median dose of LE was 3 mg (IQR: 2-5 mg). Only 31% of patients received adequate BZDs. Only 18.9% of patients with NCSE without coma received adequate BZDs (p=0.04). Among patients progressing to RSE, 75.4% had not received adequate BZDs (p=0.04) and among patients developing NCSE with coma, 80.6% did not receive adequate BZDs (p=0.07). Escalating doses of BZDs were associated with a decrease in cumulative incidences of RSE (correlation coefficient r=-0.6; p=0.04) and NCSE with coma (correlation coefficient r=-0.7; p=0.003). Outcome measures were not influenced by BZD dosing. The majority of our patients were not adequately dosed with BZDs. Inadequate BZD dosing progressed to RSE and had a tendency to lead to NCSE with coma. Our study demonstrates the need to develop a hospital-wide protocol to guide first responders in the management of SE. |
| Databáze: | OpenAIRE |
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