Predictors of outcome in refractory generalized convulsive status epilepticus.

Dilli Ram Kafle,Appu Jha Avinash,Aashish Shrestha

doi:10.1002/epi4.12394

Abstract

ObjectiveRefractory status epilepticus is a serious condition in which seizure continues despite use of two antiepileptic medications. Retrospective studies have shown that 29%‐43% of SE patients progress into RSE despite treatment. Mortality following RSE is high. We aimed to evaluate the predictors of outcome in patients with RSE at a tertiary care center.MethodsSixty‐eight consecutive patients with RSE who presented to our hospital between February 2018 and January 2020 were evaluated for outcome.ResultIn our study 28(41.2%), patients who failed to respond to first‐ and second‐line antiepileptic drug responded to the third‐line antiepileptic drug thus avoiding mechanical ventilation and intravenous anesthesia. Low GCS at admission (P < .001), need for mechanical ventilation and intravenous anesthesia (P = .018), and long duration of RSE before recovery (P = .035) were strongly associated with worse outcome. Duration of RSE before starting treatment (P = .147), previous history of seizure (P = .717), and age of the patient (P = .319) did not influence the outcome.SignificanceIn our study, we prospectively evaluated patients with RSE and followed them for one month after discharge from the hospital. Unlike some of the previous studies, we identified an interesting finding whereby a significant proportion of the patients responded to the third‐line antiepileptic drug and thus avoiding the complications related to mechanical ventilation.

Highlights

Status epilepticus is an important neurological emergency characterized by significant morbidity and mortality requiring urgent management
New-onset refractory status epilepticus (NORSE) is defined as new-onset Refractory status epilepticus (RSE) in whom no obvious cause is identified in otherwise healthy individuals.[9,10]
Mean age of the study population with RSE who were admitted to our hospital was 45.13 (Table 1)

Summary

| INTRODUCTION

Status epilepticus is an important neurological emergency characterized by significant morbidity and mortality requiring urgent management. (intravenous benzodiazepine) and one second-line medication (intravenous phenytoin or valproic acid or phenobarbitone) have been given.[3] Status epilepticus lasting more than 60 minutes has been regarded as RSE. RSE has a worse prognosis than SE which responds rapidly to medication.[3,4] Retrospective studies have shown that 29%-43% of SE patients progress into RSE despite treatment.[3,5,6,7] Risk factors for RSE include new-onset seizures, focal motor seizures, and acute CNS disorders, such as encephalitis.[8] New-onset refractory status epilepticus (NORSE) is defined as new-onset RSE in whom no obvious cause is identified in otherwise healthy individuals.[9,10]. We performed this study to evaluate the frequency, risk factors, and outcome in patients with RSE

| MATERIALS AND METHODS

Key Points

| RESULTS

| DISCUSSION