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Abstract
Objective To investigate whether receiving a second-line anticonvulsant medication that is part of a patient's home regimen influences outcomes in benzodiazepine-refractory convulsive status epilepticus.
Methods Using the Established Status Epilepticus Treatment Trial data, allocation to a study drug included in the patient's home anticonvulsant medication regimen was compared to receipt of an alternative second-line study medication. The primary outcome was cessation of clinical seizures with improved consciousness by 60 minutes after study drug initiation. Secondary outcomes were seizure cessation adjudicated from medical records and adverse events. We performed inverse probability of treatment-weighted (IPTW) logistic regressions.
Results Of 462 patients, 232 (50%) were taking 1–2 of the 3 study medications at home. The primary outcome was observed in 39/89 (44%) patients allocated to their home medication vs 76/143 (53%) allocated to a nonhome medication (IPTW odds ratio [OR] 0.66, 95% confidence interval [CI] 0.39–1.14). The adjudicated outcome occurred in 37/89 (42%) patients vs 82/143 (57%), respectively (IPTW OR 0.52, 95% CI 0.30–0.89). There was no interaction between study levetiracetam and home levetiracetam and there were no differences in adverse events.
Conclusion There was no difference in the primary outcome for patients who received a home medication vs nonhome medication. However, the retrospective evaluation suggested an association between receiving a nonhome medication and seizure cessation.
Classification of Evidence This study provides Class II evidence that for patients with refractory convulsive status epilepticus, use of a home second-line anticonvulsant compared to a nonhome anticonvulsant did not significantly affect the probability of stopping seizures.
Glossary
- CI=
- confidence interval;
- ESETT=
- Established Status Epilepticus Treatment Trial;
- IPTW=
- inverse probability of treatment weighting;
- OR=
- odds ratio;
- PNES=
- psychogenic nonepileptic spells
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work as co–first authors.
Class of Evidence: NPub.org/coe
CME Course: NPub.org/cmelist
- Received December 1, 2020.
- Accepted in final form May 11, 2021.
- © 2021 American Academy of Neurology
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