584. A review of the burden of status epilepticus, use of rescue therapy, and treatment gaps in the Asia-Oceanic region

Abstract

Abstract Background The global incidence of status epilepticus (SE) ranges from 1.3 to 41.0/100,000/year and varies substantially by region. Although data from many Asian countries are limited, this worldwide incidence is likely higher following the ILAE’s adoption of a 5-minute threshold in 2015. It is the second most frequent neurological emergency after stroke and is associated with high morbidity and mortality. Thirty-day mortality in adults is about 16%, with high variability (from 2% to 39%) and greater in low- and middle-income countries. There is a strong association between seizure duration and outcomes in SE. Rapid treatment of seizure clusters can reduce the risk of SE. Benzodiazepine rectal gel and nasal spray are specifically approved rescue medications for treating seizure clusters and SE (see Figure). Aims & Objectives Understand the burden of SE and gaps in its treatment in the Asia-Oceanic region. Method A narrative review of the scientific literature, limited to articles published in English within the last five years, was performed on PubMed and Ovid databases with a search strategy that included country names; status epilepticus; clinical practice guidelines; treatment patterns; rescue therapy; and gaps in management as keywords. Results The search returned 447 articles, of which 11 were found to be relevant. The burden of SE in the Asia-Pacific is significant. Earlier administration of appropriately dosed benzodiazepine in the pre-hospital setting is a major determinant of SE duration [8] and resultant disability. While pre-hospital assessment & treatment by paramedics is prevalent in many countries, some observe challenges such as restrictions or lack of training in the administration of benzodiazepine; under-dosing; limited availability and accessibility to newer anti-seizure medicines (ASM); and low clinician awareness of the latest evidence. Clinicians often do not follow recommendations, and their deviations from clinical practice guidelines include delayed administration of ASMs and misuse of benzodiazepine. Discussion & Conclusions Timely intervention is critical to minimizing deficits, disability, and mortality. Starting treatment early and giving adequate dosages of appropriate medication is therefore a prerequisite for a good outcome. A collaborative effort to educate, improve awareness, and make certain ASMs more readily available is recommended to achieve better clinical outcomes in SE.