Project

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DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF AN ETIOLOGIC DIAGNOSTIC TOOL FOR THE MANAGEMENT OF STATUS EPILEPTICUS

Applicant Alvarez Vincent
Number 148510
Funding scheme Early Postdoc.Mobility
Research institution Harvard Medical School Brigham and Women's Hospital
Institution of higher education Institution abroad - IACH
Main discipline Neurology, Psychiatry
Start/End 01.06.2013 - 31.05.2014
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Keywords (5)

outcome; status epilepticus; etiology; neurocritical care; epilepsy

Lay Summary (French)

Lead
L’état de mal épileptique se défini comme une crise d’épilepsie durant plus de 5 minutes. Il s’agit d’une des urgences neurologiques les plus fréquentes et, est associée à une mortalité importante pouvant aller jusqu’à 33%. Le paramètre le plus important conditionnant le devenir des patients est la cause elle-même de l’état de mal. Or, les directives internationales de traitement se concentrent sur des médications anti-convulsivantes, dirigées contre les convulsions et non contre leur cause.
Lay summary

Nous avons donc développé un outil clinique permettant d’identifier rapidement la cause de l’état de mal. Il a été conçu pour être facile à utiliser, et peut être rempli au chevet du patient.

Dans un premier temps, la précision diagnostic de cet outil sera testée dans plusieurs centres ayant une grande expérience dans le domaine. Durant un an, tous les patients traités pour un état de mal au « Brigham and Women’s Hospital », au « Massachusetts General Hospital » et au « Beth Israel Deaconess Medical Center » à Boston, ainsi qu’au « Centre Hospitalier Universitaire de Lausanne » seront inclus dans ce projet. La cause de l’état de mal suspectée initialement en utilisant notre outil diagnostic sera comparée à la cause finale retenue à la fin du séjour hospitalier et du bilan extensif.

Cette approche centrée sur l'étiologie représente un moyen novateur pour tenter d'améliorer le sort des patients souffrant d’un état de mal épileptique. De plus ce projet générera une base de données récoltée prospectivement permettant d’étudier d’autres aspects de cette urgence neurologique.


Direct link to Lay Summary Last update: 18.05.2013

Responsible applicant and co-applicants

Publications

Publication
Acute seizures in the acute ischemic stroke setting: a step forward in their description.
Alvarez Vincent (2014), Acute seizures in the acute ischemic stroke setting: a step forward in their description., in Neurology, 82(9), 740-1.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Annual Meeting of the American Academy of Neurology Poster Early identification of status epilepticus etiology with a simple clinical tool 26.04.2014 Philadelphie, United States of America Alvarez Vincent;


Abstract

With an annual incidence of 10-40 per 100 000 population, status epilepticus (SE) is one of the most frequent neurological emergency and represents a severe condition with significant mortality ranging from 7% to 33%. It is defined by the continuous occurrence of seizures lasting more than 5 minutes and can lead to permanent brain damage. Several independent predictors of poor outcome have been identified, but the most robust one is the underlying etiology.To date, international SE treatment guidelines focus on “symptomatic” treatment with sequential use of anti-epileptic drugs, and are not explicitly directed to the specific brain “insult”. Refining this “symptomatic” treatment does not seem to be the key to improve SE care, and so more efforts towards the underlying biological background seem advisable.Therefore we have develop an etiologic diagnostic tool for SE, in order to quickly identify the etiology of a SE episode. If this tool reveals the responsible factor, a specific treatment could be initiated, along with the traditional SE treatment. This tool has been designed to be easy-to-use, and can be filled at the bedside in the emergency department or in intensive care unit. It is important to test it in daily practice and evaluate its precision in SE’s etiology identification, and eventually, its impact on treatment and prognosis.For this project, this clinical tool will be implemented in four centers with a large experience in the treatment of SE: Brigham and Women’s hospital (BWH), the Massachusetts General Hospital (MGH), The Beth Israel Deaconess Medical Center (BIDMC) (all three affiliated with Harvard Medical School, Boston, MA, USA) and Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH.Regarding inclusion criteria, every adult patient fulfilling the operational definition of SE (prolonged seizures, or repeated seizures without regain of consciousness in between, lasting more than 5 min) will be included. Patients younger than 16 years old or suffering from post-anoxic SE will not be included. The tool will be filed at bedside and according to medical files. Another sheet will provide SE's characteristics (type of seizures, consciousness, duration, etc...). I will include all patients treated at the BWH, MGH and BIDMC. Dr Rossetti (head of epilepsy unit in the CHUV) will supervise patient’s inclusion in Lausanne.As a first assessment, the diagnostic precision will be evaluated by reviewing the initial suspected etiology elaborated with the tool upon admission, and the final diagnosis at discharge.Next, we will assess the impact of this tool on the patients’ clinical outcome at hospital discharge by comparing the patient’s outcome in the database of the CHUV (2006-current, more than 500 episodes) limited to patients not assessed with the tool, and the outcome following the use of this tool in all centers involved in the project. The homogeneity of cohorts will obviously be analysed first. The outcome will be categorized as Return to clinical baseline, New handicap, or Death (Fisher or ?2). We hope a 15% improvement of the proportion of patients returning to their clinical baseline (50% in cohort from the CHUV) with this tool. The calculated sample size needed to show this effect (alpha error: 0.05, power: 0.8) is 86 patients. With the “multi-center” planned enrolment, this number will be reasonably reached within a year.Because SE remains an neurological emergency with severe outcome, clinical research still need to refine its treatment. This approach centered on etiology represents an innovative way to attempt to improve the fate of patients suffering from SE.
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