Pocket Card Treats Status Epilepticus, Pitolisant Shows No Cardiac Signals, SSRIs Associated With Increased Risk of Recurrent Stroke

This week Neurology News Network covered a Cleveland Clinic study that assessed a pocket card algorithm for the multidisciplinary treatment of status epilepticus, 2 randomized studies that examined cardiac safety signals of pitolisant, and whether selective serotonin reuptake inhibitors have an impact on depressive symptoms and risk of recurrent hemorrhagic stroke in patients who survived previous intracerebral hemorrhage.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Findings from a recent study conducted at Cleveland Clinic that assessed a pocket card algorithm for the multidisciplinary treatment of status epilepticus suggest that the pocket card is a feasible, effective, and valuable educational tool for clinicians on these teams. The data showed that the interdisciplinary teams who had the pocket card available to them had shorter times to rescue therapy and similar rates of adequate dosing. At 9-month follow-up, 81% of survey respondents reporting they had the pocket card available consistently—more nurses and advanced practice providers than physician trainees. Notably, lead author Jessica R. Fesler, MD, staff epileptologist, Cleveland Clinic Epilepsy Center, and colleagues wrote that this card could “improve the implementation of updated guidelines for the treatment of status epilepticus.” They added that “frequent inappropriate dosing and timing of benzodiazepine relates to poor outcomes in status epilepticus and necessitates new methods of educating care teams,” implying that the pocket card may help fill that role.

Pooled analysis from 2 randomized studies and a 12-month open-label study presented at SLEEP 2020 demonstrated that treatment with the maximum recommended dose of pitolisant did not show any cardiac safety signals. Winter and colleagues documented a mean change in heart rate from baseline to end-of-treatment of –0.5 beats/min with pitolisant and –0.2 beats/min with placebo. Additionally, they found the mean change for both systolic and diastolic blood pressure were both similar for pitolisant versus placebo. Because cardiovascular diseases are comorbid in patients with narcolepsy, cardiovascular adverse events become a concern for those who take medication to treat their sleep condition. Heart rate increase, right bundle branch block, sinus tachycardia, and palpitations were among the cardiac AEs observed with treatment of pitolisant. Blood pressure increase, found in 1 patient, was the only cardiac AE observed in the placebo group.

Data from a longitudinal intracerebral hemorrhage cohort study revealed that selective serotonin reuptake inhibitors, or SSRIs, are associated with both improvement in depressive symptoms and increased risk of recurrent hemorrhagic stroke in patients who had survived prior ICH. SSRIs were also associated with an increased risk for ICH recurrence in those who were at high risk for recurrent ICH to begin with compared with all other survivors of ICH. Notably, patients with high risk recurrent ICH and all other ICH survivors did not differ in terms of depressive symptoms associated from SSRIs. Alessandro Biffi, neurologist, Institute for Brain Health, Massachusetts General Hospital and colleagues noted that “clinical history, neuroimaging data, and genetic biomarkers may help to identify survivors of ICH more likely to safely tolerate SSRI use.”

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