CAUSAL FACTORS AND PROGNOSIS OF STATUS EPILEPTICUS
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Purpose: To evaluate the duration, treatment and prognosis of status epilepticus (SE) in relation to cause. Of particular interest was to examine how nonadherence to prophylactic medication contributed to SE in patients with established epilepsy, as demonstrated by therapeutic drug monitoring (TDM) at admission. Methods: We retrospectively analyzed all episodes diagnosed as SE in the period from January 1999 through August 2012 at St. Olav’s Hospital, TrondheimUniversity Hospital. Data were collected by review of the medical records of the identified patients. Treatment non-adherence was investigated by TDM at admission, and was considered probable when antiepileptic drug (AED) levels were between 25% and 50% lower compared to trough levels, and as definite when they were at least 50% lower. In addition, non-adherence by history was recorded. Results: A total of 174 SE-cases were identified. The most common acute causes of SE were AED- (33 %) and fever/infection related (15%), most of these cases were early phase or established SE, with a good prognosis. However, less prevalent causes like stroke and anoxia, more often led to refractory and superrefractory SE, resulting in death or serious sequelae. Cases diagnosed with pneumonia during the course of SE, had a significantly higher mortality. A previous history of epilepsy were found in 133 (76%) cases, and although the majority had an unknown acute cause of SE (52%), treatment non-adherence and low levels of AEDs were commonly seen. Among the cases with epilepsy,124 used prophylactic treatment. TDM was performed at admission in 65 (52%), subtherapeutic AED levels were found in 25 (38%) of these, and treatment nonadherence was identified in 24 (37%). Discussion: The course and outcome of SE are largely dependent on the underlying cause. Treatment non-adherence, subtherapeutic AED levels, fever/infection and alcohol related episodes are associated with a favorable outcomeand early treatment response, whereas SE in relation to brain insults like stroke and anoxia are more treatment resistant with higher mortality and morbidity. The fact that treatment non-adherence and low AED levels were among the most common causal factors of SE in patients with epilepsy, emphasizes the importance of TDM at admission. This is the first study to demonstrate the extent of non-adherence by TDM.