Guidelines adherence in status epilepticus first steps treatment: factors associated with non-compliance and effect on outcome.

IF 4.6 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-09-01 DOI:10.1007/s00415-025-13349-w

Valérie Geiser-Micheloud, Andrea O Rossetti, Vincent Alvarez

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Abstract

Objective: We investigate adherence to acute-phase treatment guidelines for status epilepticus (SE) in a university and a community hospital, assessing factors influencing compliance and its impact on SE duration and outcomes.

Methods: We retrospectively analyzed two prospective cohorts, including 452 adults with SE (excluding post-anoxic SE). Adherence was defined as administration of a correctly dosed benzodiazepine (BZD) as first-line therapy, followed by a non-sedative antiseizure medication (ASM) as second-line treatment. We examined associations between adherence, clinical and demographic factors, and discharge outcomes.

Results: Only 129/452 (29%) patients received guideline-adherent treatment. A treatment delay > 1 h (p = 0.03) was the only factor significantly associated with non-adherence. Among 323 non-adherent treatment, 283 (89%) received a BZD, but only 66 (28%) at the correct dose. Older age, decreased consciousness, and pre-existing epilepsy influenced BZD treatment patterns. Adherence to treatment sequence did not affect clinical outcomes, but SE duration was significantly shorter in patients treated per guidelines (272 vs. 880 min, p = 0.0003).

Conclusions: Adherence to SE treatment guidelines remains low. Guideline-based treatment shortens SE duration but does not significantly impact discharge outcomes. While age, history of epilepsy and consciousness disorders influence BZD use, the lack of clear predictors of overall adherence suggests possible gaps in guideline awareness among healthcare providers.

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癫痫持续状态第一步治疗的指南依从性：不依从性的相关因素和对结果的影响。

目的：调查一所大学和一家社区医院对癫痫持续状态（SE）急性期治疗指南的依从性，评估影响依从性的因素及其对SE持续时间和结局的影响。方法：我们回顾性分析了两个前瞻性队列，包括452例SE成人（不包括缺氧后SE）。依从性定义为使用正确剂量的苯二氮卓类药物（BZD）作为一线治疗，随后使用非镇静抗癫痫药物（ASM）作为二线治疗。我们检查了依从性、临床和人口统计学因素以及出院结果之间的关系。结果：452例患者中只有129例（29%）接受了指南依从性治疗。治疗延迟bb0.1 h （p = 0.03）是唯一与不依从性显著相关的因素。在323例非依从性治疗中，283例（89%）接受了BZD，但只有66例（28%）接受了正确的剂量。年龄较大，意识下降和既往癫痫影响BZD的治疗模式。坚持治疗顺序不影响临床结果，但按照指南治疗的患者SE持续时间明显缩短（272分钟vs 880分钟，p = 0.0003）。结论：SE治疗指南的依从性仍然很低。基于指南的治疗缩短了SE持续时间，但对出院结果没有显著影响。虽然年龄、癫痫史和意识障碍影响BZD的使用，但缺乏明确的总体依从性预测指标，这表明卫生保健提供者对指南的认识可能存在差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.