Department of Emergency Medicine, Vaasa Central Hospital, Vaasa, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Neurology, Vaasa Central Hospital, Vaasa, Finland.
Epilepsy Res. 2023 Oct;196:107218. doi: 10.1016/j.eplepsyres.2023.107218. Epub 2023 Aug 25.
Second-line iv antiseizure medications (ASMs) are used to treat status epilepticus (SE), but in the emergency room setting, there might be other intended and unintended indications for administration. We wanted to explore these different indications and assess the actual usage of first- and second-line ASMs for SE with reference to other uses, such as for SE mimics.
In this retrospective study, we searched the electronic patient registry with the following terms: "epilepsy", "SE", and "seizure", during 2015. Patients at least 16 years old and treated with iv second-line ASMs were further analysed. We reassessed the indications for the use of iv ASMs based on clinical features and examinations performed.
A total of 166 episodes from 136 patients with a median age of 66 years were evaluated, constituting the following indication categories: ongoing SE (48.2%), recurrent seizures (19.3%), postictal (12.1%), seizure mimics (10.2%) and prophylactic use of ASMs (10.2%). Ongoing SE included the following subgroups: convulsive SE, focal aware SE, nonconvulsive SE (NCSE) and NCSE with coma. The seizure mimics group had a preexisting epilepsy diagnosis more often than the ongoing SE group (73% vs. 44%, p = 0.039). Ischaemic stroke was the most frequent seizure mimic. EEG was performed during hospital admission in 78% of patients with ongoing SE, 50% of patients with recurrent seizures, 75% of patients with postictal state, 53% of seizure mimic episodes and 12% of the prophylactic group. In NCSE and comatose NCSE, the diagnosis was made, and treatment was initiated only after an EEG in 52% and 30% of cases, respectively. The use of newer second-line ASMs (levetiracetam and lacosamide) was frequent in our study population. Immediate side effects of ASMs were infrequent.
Even though most of the use of ASMs was justified and administered for SE, it is a diagnostic challenge where a prior diagnosis of epilepsy can be a misleading factor, and EEG is an essential tool when clinical features are often overlapping with other acute seizure disorders. Side effects of the newer second-line ASMs after a single dose are infrequent.
二线静脉抗癫痫药物（ASMs）用于治疗癫痫持续状态（SE），但在急诊环境中，可能存在其他预期和非预期的给药适应证。我们希望探索这些不同的适应证，并评估 SE 中一线和二线 ASM 的实际使用情况，同时参考 SE 模拟发作等其他用途。
在这项回顾性研究中，我们使用了以下术语在电子患者登记处进行搜索：“癫痫”、“SE”和“发作”，时间为 2015 年。进一步分析了至少 16 岁且接受静脉二线 ASM 治疗的患者。我们根据进行的临床特征和检查，重新评估了使用静脉 ASM 的适应证。
共评估了 136 例患者的 166 个发作，构成了以下适应证类别：持续 SE（48.2%）、复发发作（19.3%）、发作后状态（12.1%）、发作模拟发作（10.2%）和 ASM 的预防性使用（10.2%）。持续 SE 包括以下亚组：惊厥性 SE、局灶性意识 SE、非惊厥性 SE（NCSE）和昏迷性 NCSE。发作模拟发作组比持续 SE 组更常存在先前的癫痫诊断（73% vs. 44%，p=0.039）。缺血性卒中是最常见的发作模拟发作。在持续 SE 中，78%的患者在住院期间进行了 EEG，50%的患者在复发发作时进行了 EEG，75%的患者在发作后状态下进行了 EEG，53%的发作模拟发作患者进行了 EEG，而预防性治疗组中仅 12%的患者进行了 EEG。在 NCSE 和昏迷性 NCSE 中，只有在 EEG 检查后才做出诊断并开始治疗，分别占 52%和 30%。在我们的研究人群中，新的二线 ASM（左乙拉西坦和拉科酰胺）的使用很常见。 ASM 的即时不良反应很少见。
尽管 ASM 的大部分使用是合理的，并且用于 SE，但这是一个具有挑战性的诊断，先前的癫痫诊断可能是一个误导因素，当临床特征经常与其他急性发作性疾病重叠时，EEG 是一种必不可少的工具。单次剂量后新的二线 ASM 的不良反应很少见。
