Third-Line Antiepileptic Treatment Outcomes in Refractory Status Epilepticus

Objective: To determine which patient features are predictive of outcome in those presenting with status epilepticus, compare and contrast those who responded to second-line therapy to those requiring third-line, and evaluate the relationship between number of third-line agents and outcome. Background: Although there has been much research and several clinical trials (ex ESETT) addressing the use of second-line agents in the treatment of benzodiazepine refractory status epilepticus, there has been little research done on third-line agents and their effects on outcome. Design/Methods: Retrospective comparative analysis conducted at a level 4 epilepsy center at University Hospital in San Antonio over 3 years from 2013 to 2015. Inclusion criteria included patients 18 years and older with a diagnosis of status epilepticus. Characteristics of age, gender, intubation rate, ventilation time, vasopressor use, history of epilepsy, EEG resolution, seizure type, etiology, length of hospital stay, third-line agent used, and Glasgow outcome score at discharge were compared and evaluated for statistical significance. Results: Factors that correlated with worse outcomes included advanced age, first time seizure, vasopressor use, and prolonged hospital stay. Intubation and vasopressor use were more common in patients who received a third-line agent. Breakthrough seizures correlated with better outcomes while anoxic brain injury correlated with worse outcomes. There was no difference in Glasgow outcome score at discharge between patients that received a third-line agent and those that responded to second-line therapy. However, increasing the number of third-line agents beyond one proportionately led to poorer outcomes. Conclusions: It may be possible to create status epilepticus treatment algorithms tailored to specific subpopulations. Using these results, status epilepticus may be anticipated earlier in its course and treated sooner. Information regarding antiepileptic therapy may be used to prevent status epilepticus in the future. It may be possible to design a randomized prospective trial to further evaluate outcomes related to third-line therapy. Disclosure: Dr. Ellis has nothing to disclose. Dr. Morgan has nothing to disclose.