{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:04:57Z","timestamp":1789617897790,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,4,7]],"date-time":"2019-04-07T00:00:00Z","timestamp":1554595200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Examine the association of duration of therapeutic coma (<jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content>) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (<jats:styled-content style=\"fixed-case\">RSE<\/jats:styled-content>). Define an optimal window for <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> that provides sustained seizure control and minimizes complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective, observational cohort study involving patients who presented with <jats:styled-content style=\"fixed-case\">RSE<\/jats:styled-content> to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> with primary and secondary outcomes was evaluated using two\u2010sample <jats:italic>t<\/jats:italic> tests, simple linear regression, and chi\u2010square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> for seizure recurrence was quantified using a receiver\u2010operating characteristic curve. Youden index was used to determine an optimal cutoff value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> (27.2 vs 15.6\u00a0hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.038) but not with poor functional neurologic outcome upon discharge, in\u2010hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> were independently associated with fewer in\u2010hospital complications (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35\u00a0hours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>This study suggests that a shorter duration yet deeper <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> as treatment for <jats:styled-content style=\"fixed-case\">RSE<\/jats:styled-content> may be more effective and safer than the currently recommended <jats:styled-content style=\"fixed-case\">TC<\/jats:styled-content> duration of 24\u201048\u00a0hours. Prospective and randomized trials should be conducted to validate these assertions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.14706","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T05:24:23Z","timestamp":1554701063000},"page":"921-934","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Duration of therapeutic coma and outcome of refractory status epilepticus"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3246-6070","authenticated-orcid":false,"given":"Wolfgang G.","family":"Muhlhofer","sequence":"first","affiliation":[{"name":"Department of Neurology\/Epilepsy Center University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Layfield","sequence":"additional","affiliation":[{"name":"Department of Neurology Case Western Reserve University Hospitals  Cleveland Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lowenstein","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Francisco  San Francisco California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee Paul","family":"Lin","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Science University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Informatics Institute Center for Clinical and Translational Science University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalini","family":"Saini","sequence":"additional","affiliation":[{"name":"Information Technology Department at School of Medicine Department of Medicine University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy P.","family":"Szaflarski","sequence":"additional","affiliation":[{"name":"Department of Neurology\/Epilepsy Center University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,7]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0074-7742(06)81007-X"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-013-9935-x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9695-z"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/13696998.2016.1223680"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13584"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597-16.1.48"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02917.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm5050054"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003224"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182591ff1"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000881"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000009"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-016-8074-7"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2002.28501.x"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1999.tb00775.x"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0154-1"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2016.0855"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2001.27500.x"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-010-9445-z"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(03)00036-4"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13121"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116813"},{"key":"e_1_2_9_24_1","volume-title":"Statistics for biology and health. Regression methods in biostatistics: Linear, logistic, survival, and repeated measures models","author":"Vittinghoff E","year":"2005"},{"key":"e_1_2_9_25_1","volume-title":"Logistic regression using SAS\u00ae: theory and application","author":"Allison PD","year":"2012"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11135-006-9018-6"},{"key":"e_1_2_9_27_1","volume-title":"Applied linear regression models","author":"Kutner MH","year":"2004"},{"key":"e_1_2_9_28_1","unstructured":"Office of Health and Ecological Effects 1979"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0587.2012.07348.x"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v061.i08"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000054"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2014.11.007"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-016-0294-2"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0000000000000232"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1080\/21556660.2017.1396992"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.080887"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-014-0080-y"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-008-0989-1"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2017.01.004"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2017.12.007"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002843"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2017.04.005"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a005736"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1989.41"},{"key":"e_1_2_9_45_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198917050-00002"},{"key":"e_1_2_9_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2017.11.009"},{"key":"e_1_2_9_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-006-0362-8"},{"key":"e_1_2_9_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2017.11.006"},{"key":"e_1_2_9_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2017.2459"},{"key":"e_1_2_9_50_1","first-page":"CD003843","article-title":"Bispectral index for improving anaesthetic delivery and postoperative recovery","volume":"4","author":"Punjasawadwong Y","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/WNP.0b013e3182784729"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fepi.14706","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.14706","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/epi.14706","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/epi.14706","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T01:29:58Z","timestamp":1694050198000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/epi.14706"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,7]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1111\/epi.14706"],"URL":"https:\/\/doi.org\/10.1111\/epi.14706","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,7]]},"assertion":[{"value":"2018-10-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}