Factors associated with resistance to benzodiazepines in status epilepticus
To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode. All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019....
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| Veröffentlicht in: | Journal of the neurological sciences 2021-04, Vol.423, p.117368-117368, Article 117368 |
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| container_title | Journal of the neurological sciences |
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| creator | Llauradó, Arnau Quintana, Manuel Ballvé, Alejandro Campos, Daniel Fonseca, Elena Abraira, Laura Toledo, Manuel Santamarina, Estevo |
| description | To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode.
All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed.
Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p |
| doi_str_mv | 10.1016/j.jns.2021.117368 |
| format | Article |
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All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed.
Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001).
The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
•There is a delay in the start of BZD treatment in non-convulsive status epilepticus.•Status epilepticus secondary to an acute brain injury respond poorly to BZDs.•BZD resistance increases over the time in status epilepticus due to chronic lesion.•BZD administration within the first 4.5 h is associated with shorter duration.</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2021.117368</identifier><identifier>PMID: 33652289</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Anticonvulsants - therapeutic use ; Benzodiazepines ; Benzodiazepines - therapeutic use ; Epilepsy ; Epilepsy - drug therapy ; Etiology ; Humans ; Prognosis ; Seizures - drug therapy ; Status epilepticus ; Status Epilepticus - drug therapy</subject><ispartof>Journal of the neurological sciences, 2021-04, Vol.423, p.117368-117368, Article 117368</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-4d54347c51ef1ddfa7db6029dcbd595434ef6215c10864161a77e34f09c4b2df3</citedby><cites>FETCH-LOGICAL-c353t-4d54347c51ef1ddfa7db6029dcbd595434ef6215c10864161a77e34f09c4b2df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022510X21000617$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33652289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Llauradó, Arnau</creatorcontrib><creatorcontrib>Quintana, Manuel</creatorcontrib><creatorcontrib>Ballvé, Alejandro</creatorcontrib><creatorcontrib>Campos, Daniel</creatorcontrib><creatorcontrib>Fonseca, Elena</creatorcontrib><creatorcontrib>Abraira, Laura</creatorcontrib><creatorcontrib>Toledo, Manuel</creatorcontrib><creatorcontrib>Santamarina, Estevo</creatorcontrib><title>Factors associated with resistance to benzodiazepines in status epilepticus</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode.
All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed.
Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001).
The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
•There is a delay in the start of BZD treatment in non-convulsive status epilepticus.•Status epilepticus secondary to an acute brain injury respond poorly to BZDs.•BZD resistance increases over the time in status epilepticus due to chronic lesion.•BZD administration within the first 4.5 h is associated with shorter duration.</description><subject>Aged</subject><subject>Anticonvulsants - therapeutic use</subject><subject>Benzodiazepines</subject><subject>Benzodiazepines - therapeutic use</subject><subject>Epilepsy</subject><subject>Epilepsy - drug therapy</subject><subject>Etiology</subject><subject>Humans</subject><subject>Prognosis</subject><subject>Seizures - drug therapy</subject><subject>Status epilepticus</subject><subject>Status Epilepticus - drug therapy</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1KLDEQhYMoOv48gJtLL--mx1TSSadxJeIfCm4U3IV0Uo0ZZrrnptKKPr09jN6lq4Kq7xyoj7FT4HPgoM8W80VPc8EFzAFqqc0Om4GpTamMkbtsxrkQpQL-csAOiRacc21Ms88OpNRKCNPM2P2183lIVDiiwUeXMRTvMb8WCSlSdr3HIg9Fi_3nEKL7xHXskYrYF9Mxj1RMiyWuc_QjHbO9zi0JT77nEXu-vnq6vC0fHm_uLi8eSi-VzGUVVCWr2ivADkLoXB1azUUTfBtUs7lhpwUoD9zoCjS4ukZZdbzxVStCJ4_Y323vOg3_RqRsV5E8Lpeux2EkK6pGi6oGVU8obFGfBqKEnV2nuHLpwwK3G4d2YSeHduPQbh1OmT_f9WO7wvA_8SNtAs63AE5PvkVMlnzEyVSICX22YYi_1H8Be3eCuw</recordid><startdate>20210415</startdate><enddate>20210415</enddate><creator>Llauradó, Arnau</creator><creator>Quintana, Manuel</creator><creator>Ballvé, Alejandro</creator><creator>Campos, Daniel</creator><creator>Fonseca, Elena</creator><creator>Abraira, Laura</creator><creator>Toledo, Manuel</creator><creator>Santamarina, Estevo</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210415</creationdate><title>Factors associated with resistance to benzodiazepines in status epilepticus</title><author>Llauradó, Arnau ; Quintana, Manuel ; Ballvé, Alejandro ; Campos, Daniel ; Fonseca, Elena ; Abraira, Laura ; Toledo, Manuel ; Santamarina, Estevo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-4d54347c51ef1ddfa7db6029dcbd595434ef6215c10864161a77e34f09c4b2df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Anticonvulsants - therapeutic use</topic><topic>Benzodiazepines</topic><topic>Benzodiazepines - therapeutic use</topic><topic>Epilepsy</topic><topic>Epilepsy - drug therapy</topic><topic>Etiology</topic><topic>Humans</topic><topic>Prognosis</topic><topic>Seizures - drug therapy</topic><topic>Status epilepticus</topic><topic>Status Epilepticus - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Llauradó, Arnau</creatorcontrib><creatorcontrib>Quintana, Manuel</creatorcontrib><creatorcontrib>Ballvé, Alejandro</creatorcontrib><creatorcontrib>Campos, Daniel</creatorcontrib><creatorcontrib>Fonseca, Elena</creatorcontrib><creatorcontrib>Abraira, Laura</creatorcontrib><creatorcontrib>Toledo, Manuel</creatorcontrib><creatorcontrib>Santamarina, Estevo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Llauradó, Arnau</au><au>Quintana, Manuel</au><au>Ballvé, Alejandro</au><au>Campos, Daniel</au><au>Fonseca, Elena</au><au>Abraira, Laura</au><au>Toledo, Manuel</au><au>Santamarina, Estevo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with resistance to benzodiazepines in status epilepticus</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2021-04-15</date><risdate>2021</risdate><volume>423</volume><spage>117368</spage><epage>117368</epage><pages>117368-117368</pages><artnum>117368</artnum><issn>0022-510X</issn><eissn>1878-5883</eissn><abstract>To investigate factors related to benzodiazepine (BZD) resistance in status epilepticus (SE) with a focus on their relationship with the etiology of the episode.
All SE cases in patients aged >16 years treated with BZDs were prospectively collected in our center from February 2011 to April 2019. The registry included demographics, SE type and etiology, the timing and duration of BZD administration, and the outcome. In total, 371 episodes were analyzed.
Median age at SE onset was 61.3 years; the most frequent etiology was acute symptomatic (55.8%). SE with prominent motor symptoms occurred in 63.3%. Median time to BZD administration was 2 h. We studied the correlation between two-time variables: time from SE onset to BZD administration and time from BZD administration to resolution of SE (response); we observed that timely administration correlated with a faster response in patients with prominent motor symptoms (p = 0.017), SE due to a chronic structural cerebral lesion (p = 0.004), and patients with a history of seizures (p = 0.013). In these subgroups (prominent motor symptoms or chronic structural lesion) BZD administration within the first 4.5 h was highly associated with shorter post-BZD SE duration (p < 0.001).
The relationship between prompt BZD administration and subsequent duration of SE was found to depend to some extent on the etiology of the episode: patients with chronic structural lesions and those with previous epilepsy responded faster to BZDs. Semiology may have also its impact, as the presence of prominent motor symptoms showed also a faster response.
•There is a delay in the start of BZD treatment in non-convulsive status epilepticus.•Status epilepticus secondary to an acute brain injury respond poorly to BZDs.•BZD resistance increases over the time in status epilepticus due to chronic lesion.•BZD administration within the first 4.5 h is associated with shorter duration.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>33652289</pmid><doi>10.1016/j.jns.2021.117368</doi><tpages>1</tpages></addata></record> |
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| subjects | Aged Anticonvulsants - therapeutic use Benzodiazepines Benzodiazepines - therapeutic use Epilepsy Epilepsy - drug therapy Etiology Humans Prognosis Seizures - drug therapy Status epilepticus Status Epilepticus - drug therapy |
| title | Factors associated with resistance to benzodiazepines in status epilepticus |
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