naa a22 4500 510800270 CHVBK 20180411083352.0 cr unu---uuuuu 180411e20130401xx s 000 0 eng 10.1007/s12028-012-9785-y doi (NATIONALLICENCE)springer-10.1007/s12028-012-9785-y Calculating the Risk Benefit Equation for Aggressive Treatment of Non-convulsive Status Epilepticus [Elektronische Daten] [Matthew Ferguson, Matt Bianchi, Raoul Sutter, Eric Rosenthal, Sydney Cash, Peter Kaplan, M. Westover] Objective: To address the question: does non-convulsive status epilepticus warrant the same aggressive treatment as convulsive status epilepticus? Methods: We used a decision model to evaluate the risks and benefits of treating non-convulsive status epilepticus with intravenous anesthetics and ICU-level aggressive care. We investigated how the decision to use aggressive versus non-aggressive management for non-convulsive status epilepticus impacts expected patient outcome for four etiologies: absence epilepsy, discontinued antiepileptic drugs, intraparenchymal hemorrhage, and hypoxic ischemic encephalopathy. Each etiology was defined by distinct values for five key parameters: baseline mortality rate of the inciting etiology; efficacy of non-aggressive treatment in gaining control of seizures; the relative contribution of seizures to overall mortality; the degree of excess disability expected in the case of delayed seizure control; and the mortality risk of aggressive treatment. Results: Non-aggressive treatment was favored for etiologies with low morbidity and mortality such as absence epilepsy and discontinued antiepileptic drugs. The risk of aggressive treatment was only warranted in etiologies where there was significant risk of seizure-induced neurologic damage. In the case of post-anoxic status epilepticus, expected outcomes were poor regardless of the treatment chosen. The favored strategy in each case was determined by strong interactions of all five model parameters. Conclusions: Determination of the optimal management approach to non-convulsive status epilepticus is complex and is ultimately determined by the inciting etiology. Springer Science+Business Media New York, 2012 Non-convulsive status epilepticus nationallicence Risk benefit analysis nationallicence NCSE nationallicence Decision analysis nationallicence Ferguson Matthew Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut Bianchi Matt Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut Sutter Raoul Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Rosenthal Eric Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut Cash Sydney Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut Kaplan Peter Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA aut Westover M. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut Neurocritical Care Humana Press Inc 18/2(2013-04-01), 216-227 1541-6933 18:2<216 2013 18 12028 https://doi.org/10.1007/s12028-012-9785-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9785-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ferguson Matthew Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut NATIONALLICENCE 700 1- Bianchi Matt Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut NATIONALLICENCE 700 1- Sutter Raoul Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Rosenthal Eric Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut NATIONALLICENCE 700 1- Cash Sydney Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut NATIONALLICENCE 700 1- Kaplan Peter Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Westover M. Department of Neurology, Massachusetts General Hospital, Boston, MA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/2(2013-04-01), 216-227 1541-6933 18:2<216 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer