Treatment and course of different subtypes of status epilepticus.

Since randomized controlled trials are difficult to perform for ethical reasons in a potentially deadly condition like status epilepticus (SE), a retrospective database analysis may be welcome to broaden the evidence for the treatment of SE. In this retrospective study we evaluated every SE treatment at the neurological department of the University of Rostock from January 2000 to December 2009 in order to determine the efficacy of different antiepileptic drugs (AEDs) in terminating different kinds of SE. We analyzed the frequency of refractory courses in different types of SE, at which time which AED was administered and at which time which AED was effective to terminate the different epileptic conditions. A second aim of this study was to evaluate the course and the outcome of different kinds of SE. Statistical comparisons were performed with the χ(2)-test. 167 episodes of SE in 118 patients could be evaluated. The efficacy rates of AEDs differed significantly, mainly due to the superior efficacy of clonazepam (CZP). CZP seemed to be more effective than DZP, LEV, MDM and VPA in terminating generalized convulsive status epilepticus (GCSE), whereas there was no significant difference in the efficacy for terminating nonconvulsive status epilepticus (NCSE) and epilepsia partialis continua (EPC) between the used AEDs. Anaesthesia and CZP both terminated GCSE more effectively than NCSE and EPC. Concerning the course of the different kinds of SE the following results were obtained: 13 patients died during hospital treatment. Treatment in NCSE and EPC started significantly later than in GCSE. There was no significant difference in mortality between the types of SE. However the frequency of refractory courses differed between the types of SE. At the time of SE termination without the administration of anaesthesia a combination therapy using 2 or more AEDs was established in most episodes.

Efficacy of intravenous lacosamide in refractory nonconvulsive status epilepticus and simple partial status epilepticus.

Nonconvulsive status epilepticus (NCSE) and epilepsia partialis continua (EPC) are common epileptic conditions for which straightforward recommendations based on controlled randomized trials for treatment in therapy refractory courses are lacking. In a large retrospective study on drug efficacy in status epilepticus (SE) we identified the patients treated in our department by searching for the term "status epilepticus" in the electronic archive of medical reports of our clinic. Here we present the subset of data concerning the patients treated with lacosamide (LCM). Ten episodes of SE in nine patients could be analyzed. To control for age dependency of results at discharge we calculated a Spearman correlation coefficient with age as independent variable and return to baseline Modified Rankin Score (mRS) at discharge=1, worsening of condition at discharge (i.e. new neurological deficit or worsening of mRS)=2 and death in hospital=3 as dependent variables. LCM was given in dosages of 50-100mg. It was not earlier administered than as fourth drug. Nevertheless it seemed to be effective for termination of status epilepticus in 20% of the episodes. But the outcome at discharge seemed considerably to depend on age of patients (r=0.94, explaining 89% of variance).