What is Specialized Care in Status Epilepticus and in Which ICU?
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EDITORIAL
What is Specialized Care in Status Epilepticus and in Which ICU? Sophie Demeret • Nicolas Weiss • Francis Bolgert Vincent Navarro
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Published online: 29 May 2013 Ó Springer Science+Business Media New York 2013
Status epilepticus (SE) is a serious, potentially life-threatening condition. The outcome of SE is variable, while some patients may present neurological deficits, others recover without sequellae. The reasons for these different outcomes are not fully understood, but some prognostic factors have been identified, such as the age, the clinical type of SE, a previous history of epilepsy, the etiology, and the delay of treatment onset [1–3].
S. Demeret N. Weiss F. Bolgert Neurological Intensive Care Unit, Neurology Department, Groupe Hospitalier Pitie´-Salpeˆtrie`re, Assistance Publique— Hoˆpitaux de Paris and Universite´ Pierre et Marie Curie Paris 6, Paris, France S. Demeret N. Weiss F. Bolgert V. Navarro Institut Hospitalo-Universitaire—Institut de Neurosciences Translationnelles de Paris, Groupe Hospitalier Pitie´-Salpeˆtrie`re, Assistance Publique—Hoˆpitaux de Paris and Universite´ Pierre et Marie Curie Paris 6, Paris, France V. Navarro Departments of Neurophysiology and Neurology, Groupe Hospitalier Pitie´-Salpeˆtrie`re, Assistance Publique—Hoˆpitaux de Paris and Universite´ Pierre et Marie Curie Paris 6, Paris, France V. Navarro Cortex and Epilepsy Team, Centre de Recherche de l’Institut du Cerveau de la Moelle (INSERM UMRS795—CNRS UMR 7225—UPMC), ICM, Paris, France N. Weiss (&) Neurological Intensive Care Unit, Neurology Department, La Pitie´-Salpeˆtrie`re Hospital, Assistance Publique—Hoˆpitaux de Paris and Universite´ Pierre et Marie Curie Paris 6, Paris, France e-mail: [email protected]
Despite being an important stage in the treatment, there have been very few studies on the various management options when patients are admitted in intensive care. In this retrospective study, Valeras et al. compared the management and outcome of 168 cases of SE admitted to either a neurological intensive care unit (NICU) (27 %) or a medical intensive care unit (MICU) (73 %) in the same tertiary care hospital. The authors did not find a significant difference in terms of length of hospital stay, mortality, or outcome at discharge. This finding remained after adjustment for confounding factors. However, on admission, there were significant differences between the patient groups. Stroke accounted for 39 % and toxic and metabolic etiologies for 11 % of cases in the NICU group compared to 12 and 21 %, respectively, in the MICU group. The APACHE-II severity score at admission was higher in the MICU group than in the NICU group (17.5 vs. 13.4), as was consciousness impairment (48 vs. 22 %). There was no significant difference in terms of mortality, even if a trend to decreased mortality existed in NICU (4 % in the NICU group; 8 % in the MICU group) and no difference in outcome according to Rankin score. Regarding the management modalities, the only significant difference related to continuous
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