Camilla Allegri (Italy)
Azienda Ospedaliero Universitaria Verona Department of Intensive CareAuthor Of 1 Presentation
SUPER-REFRACTORY STATUS EPILEPTICUS AFTER CARDIAC ARREST: AGGRESSIVE TREATMENT GUIDED BY MULTIMODAL PROGNOSTIC INDICATORS (SUPER-CAT)
- Simone Beretta (Italy)
Abstract
Background and Aims:
The aim of the SUPER-CAT study is to investigate the efficacy and safety of a double antiglutamatergic therapy as compared with a non-antiglutamatergic therapy for super refractory status epilepticus in survivors of cardiac arrest with favorable prognostic indicators.
Methods:
In a retrospective cohort study, 48 comatose patients with post-anoxic super refractory status epilepticus and <= 2 out of 5 poor neurologic prognostic indicators were included in the study. Patients treated with a standardized double antiglutamatergic treatment (n = 26; ketamine 1.5-7.5 mg/kg/hour according to EEG target for 3 days + perampanel 12 mg/day for 5 days followed by gradual tapering) were compared to patients treated with non-standardized, non-antiglutamatergic treatments (n = 22). Primary efficacy outcomes were resolution of status epilepticus and cerebral performance category (CPC) at 6 months. The primary safety outcome was in-hospital mortality.
Results:
The proportion of patients with resolution of status epilepticus was 81% in the double antiglutamatergic treatment group versus 45% in the non-antiglutamatergic treatment group (absolute difference 23%; OR 4.3; p=0.007). A good neurological outcome at 6 months (CPC 0 to 2) was achieved by 41% of patients in the antiglutamatergic treatment group versus 18% in the non-antiglutamatergic treatment group (absolute difference 23%; OR 3.1; p=0.07). In-hospital mortality was 15% in the antiglutamatergic treatment group versus 64% in the non-antiglutamatergic treatment group (absolute difference 49%; OR 0.09; p=0.0025).
Conclusions:
Selected patients with post-anoxic super-refractory status epilepticus can benefit a sustained and intensive treatment. A standardized double antiglutamatergic therapy is a promising therapeutic option for these patients.