Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University and University Hospital Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany.
LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
CNS Drugs. 2023 Nov;37(11):993-1008. doi: 10.1007/s40263-023-01049-w. Epub 2023 Nov 18.
Over the last decade, significant advancements have been made in status epilepticus (SE) management, influenced by landmark trials such as ESETT and RAMPART. The objectives of this study were to explore the evolution of drug treatments for patients with SE, to investigate its association with outcomes and mortality, and to evaluate differences in treatment patterns between adults and children for a potential shift in medication trends due to the above mentioned trials.
The medical records of patients with SE treated at University Hospital Frankfurt between 2012 and 2021 were evaluated for medication trends and outcomes. Children and adults were analyzed separately and jointly.
This study included 1151 SE episodes in 1021 patients (mean age = 53.3 ± 28.3 years; 52.5 % female [n = 533]). The overall percentage of patients with SE treated prehospital was stable over the last decade. More than half (53.6 %) of children were treated prehospital, compared with less than one-third (26.7 %) of adults. Prehospital midazolam use increased over time, while diazepam use decreased. Lorazepam was the most commonly used benzodiazepine in hospitals in 2012-2013, used in 40.8 % of all episodes. However, its use declined to 27.2 % in 2020-2021, while midazolam use increased to 44.0 %. While the use of older antiseizure medications (ASMs) such as phenobarbital (p = 0.02), phenytoin (p < 0.001), and valproate (p < 0.001) decreased, the use of newer ASMs such as levetiracetam and lacosamide significantly increased (p < 0.001). Propofol and continuous midazolam infusion remained the most used third-line therapy drugs. Overall mortality was 16.5 % at discharge and 18.9 % at 30 days. Mortality rates did not change between 2012 and 2021.
Midazolam has become the preferred benzodiazepine in pre- and in-hospital settings, both in children and adults. The same applies to the increased use of levetiracetam and lacosamide over time in children and adults, while phenobarbital, phenytoin, and valproate use decreased. Continuous midazolam infusion and propofol remain the most frequently used anesthetic drugs. Mortality and outcome remain stable despite changes in medication patterns.
在过去的十年中，由于 ESETT 和 RAMPART 等里程碑式试验的影响，癫痫持续状态（SE）的治疗取得了重大进展。本研究的目的是探讨 SE 患者药物治疗的演变，研究其与结局和死亡率的关系，并评估由于上述试验，成年人和儿童之间的治疗模式差异，以评估药物治疗趋势的潜在变化。
评估了 2012 年至 2021 年在法兰克福大学医院治疗的 SE 患者的药物治疗趋势和结局。分别和联合分析了儿童和成人患者。
本研究纳入了 1021 例患者的 1151 例 SE 发作（平均年龄=53.3±28.3 岁；52.5%为女性[n=533]）。过去十年间，院前治疗 SE 的患者比例总体保持稳定。超过一半（53.6%）的儿童在院前接受治疗，而不到三分之一（26.7%）的成人在院前接受治疗。咪达唑仑的院前使用率随着时间的推移而增加，而地西泮的使用率则下降。劳拉西泮是 2012-2013 年医院最常用的苯二氮䓬类药物，在所有发作中占 40.8%。然而，它的使用率在 2020-2021 年下降至 27.2%，而咪达唑仑的使用率上升至 44.0%。虽然 older ASMs 的使用率下降，如苯巴比妥（p=0.02）、苯妥英（p<0.001）和丙戊酸钠（p<0.001），但新型 ASMs，如左乙拉西坦和拉科酰胺的使用率显著增加（p<0.001）。丙泊酚和持续咪达唑仑输注仍然是最常用的三线治疗药物。出院时的总死亡率为 16.5%，30 天时为 18.9%。2012 年至 2021 年期间，死亡率没有变化。
咪达唑仑已成为儿童和成人院前和院内治疗的首选苯二氮䓬类药物。随着时间的推移，左乙拉西坦和拉科酰胺在儿童和成人中的使用率增加，而苯巴比妥、苯妥英和丙戊酸钠的使用率下降，情况也是如此。持续咪达唑仑输注和丙泊酚仍然是最常用的麻醉药物。尽管药物治疗模式发生了变化，但死亡率和结局仍保持稳定。
