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Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

BACKGROUND: We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs). METHODS: This was a multicenter retrospectiv...

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Autores principales: Stetefeld, Henning R., Schaal, Alexander, Scheibe, Franziska, Nichtweiß, Julia, Lehmann, Felix, Müller, Marcus, Gerner, Stefan T., Huttner, Hagen B., Luger, Sebastian, Fuhrer, Hannah, Bösel, Julian, Schönenberger, Silvia, Dimitriadis, Konstantinos, Neumann, Bernhard, Fuchs, Kornelius, Fink, Gereon R., Malter, Michael P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692280/
https://www.ncbi.nlm.nih.gov/pubmed/34286464
http://dx.doi.org/10.1007/s12028-021-01250-z
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author Stetefeld, Henning R.
Schaal, Alexander
Scheibe, Franziska
Nichtweiß, Julia
Lehmann, Felix
Müller, Marcus
Gerner, Stefan T.
Huttner, Hagen B.
Luger, Sebastian
Fuhrer, Hannah
Bösel, Julian
Schönenberger, Silvia
Dimitriadis, Konstantinos
Neumann, Bernhard
Fuchs, Kornelius
Fink, Gereon R.
Malter, Michael P.
author_facet Stetefeld, Henning R.
Schaal, Alexander
Scheibe, Franziska
Nichtweiß, Julia
Lehmann, Felix
Müller, Marcus
Gerner, Stefan T.
Huttner, Hagen B.
Luger, Sebastian
Fuhrer, Hannah
Bösel, Julian
Schönenberger, Silvia
Dimitriadis, Konstantinos
Neumann, Bernhard
Fuchs, Kornelius
Fink, Gereon R.
Malter, Michael P.
author_sort Stetefeld, Henning R.
collection PubMed
description BACKGROUND: We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs). METHODS: This was a multicenter retrospective study of patients with RSE/SRSE treated with isoflurane for status epilepticus termination admitted to the neuro-ICUs of nine German university centers during 2011–2018. RESULTS: We identified 45 patients who received isoflurane for the treatment of RSE/SRSE. During isoflurane treatment, electroencephalograms showed no epileptiform discharges in 33 of 41 (80%) patients, and burst suppression pattern was achieved in 29 of 41 patients (71%). RSE/SRSE was finally terminated after treatment with isoflurane in 23 of 45 patients (51%) for the entire group and in 13 of 45 patients (29%) without additional therapy. Lengths of stay in the hospital and in the neuro-ICU were significantly extended in cases of ongoing status epilepticus under isoflurane treatment (p = 0.01 for length of stay in the hospital, p = 0.049 for length in the neuro-ICU). During isoflurane treatment, side effects were reported in 40 of 45 patients (89%) and mainly included hypotension (n = 40, 89%) and/or infection (n = 20, 44%). Whether side effects occurred did not affect the outcome at discharge. Of 22 patients with follow-up magnetic resonance imaging, 2 patients (9%) showed progressive magnetic resonance imaging alterations that were considered to be potentially associated with RSE/SRSE itself or with isoflurane therapy. CONCLUSIONS: Isoflurane was associated with a good effect in stopping RSE/SRSE. Nevertheless, establishing remission remained difficult. Side effects were common but without effect on the outcome at discharge. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12028-021-01250-z.
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spelling pubmed-86922802022-01-07 Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation Stetefeld, Henning R. Schaal, Alexander Scheibe, Franziska Nichtweiß, Julia Lehmann, Felix Müller, Marcus Gerner, Stefan T. Huttner, Hagen B. Luger, Sebastian Fuhrer, Hannah Bösel, Julian Schönenberger, Silvia Dimitriadis, Konstantinos Neumann, Bernhard Fuchs, Kornelius Fink, Gereon R. Malter, Michael P. Neurocrit Care Original Work BACKGROUND: We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs). METHODS: This was a multicenter retrospective study of patients with RSE/SRSE treated with isoflurane for status epilepticus termination admitted to the neuro-ICUs of nine German university centers during 2011–2018. RESULTS: We identified 45 patients who received isoflurane for the treatment of RSE/SRSE. During isoflurane treatment, electroencephalograms showed no epileptiform discharges in 33 of 41 (80%) patients, and burst suppression pattern was achieved in 29 of 41 patients (71%). RSE/SRSE was finally terminated after treatment with isoflurane in 23 of 45 patients (51%) for the entire group and in 13 of 45 patients (29%) without additional therapy. Lengths of stay in the hospital and in the neuro-ICU were significantly extended in cases of ongoing status epilepticus under isoflurane treatment (p = 0.01 for length of stay in the hospital, p = 0.049 for length in the neuro-ICU). During isoflurane treatment, side effects were reported in 40 of 45 patients (89%) and mainly included hypotension (n = 40, 89%) and/or infection (n = 20, 44%). Whether side effects occurred did not affect the outcome at discharge. Of 22 patients with follow-up magnetic resonance imaging, 2 patients (9%) showed progressive magnetic resonance imaging alterations that were considered to be potentially associated with RSE/SRSE itself or with isoflurane therapy. CONCLUSIONS: Isoflurane was associated with a good effect in stopping RSE/SRSE. Nevertheless, establishing remission remained difficult. Side effects were common but without effect on the outcome at discharge. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12028-021-01250-z. Springer US 2021-07-20 2021 /pmc/articles/PMC8692280/ /pubmed/34286464 http://dx.doi.org/10.1007/s12028-021-01250-z Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Work
Stetefeld, Henning R.
Schaal, Alexander
Scheibe, Franziska
Nichtweiß, Julia
Lehmann, Felix
Müller, Marcus
Gerner, Stefan T.
Huttner, Hagen B.
Luger, Sebastian
Fuhrer, Hannah
Bösel, Julian
Schönenberger, Silvia
Dimitriadis, Konstantinos
Neumann, Bernhard
Fuchs, Kornelius
Fink, Gereon R.
Malter, Michael P.
Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title_full Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title_fullStr Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title_full_unstemmed Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title_short Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation
title_sort isoflurane in (super-) refractory status epilepticus: a multicenter evaluation
topic Original Work
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692280/
https://www.ncbi.nlm.nih.gov/pubmed/34286464
http://dx.doi.org/10.1007/s12028-021-01250-z
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