Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

O H Hernandez,J F Zapata,J C Arango,H Delgado,A Guerra,J D Ciro,M Massaro,J I Suarez,M Jimenez

doi:10.1155/2014/821462

Abstract

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.

Highlights

Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment
We conducted a retrospective study that included all patients in the NeuroICU at the Instituto Neurologico de Colombia (Medellin, Colombia), in whom the diagnosis of RSE was made between September 2007 and December 2008
A Cadwell equipment with 32 channels and surface electrodes was used, following the protocol according to the International 10–20 System; electrodes were installed for electrocardiogram monitoring, surface electromyography in both deltoids, and in some cases, electrooculogram, depending on the clinical symptoms reported

Summary

Introduction

Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. In the Intensive Care Unit (ICU) there are two groups of patients with SE: patients with multiple episodes of clinical seizures who have various response to initial management, and there are individuals admitted for other reasons who developed subclinical ictal episodes during their stay in the ICU. The latter is classified as nonconvulsive status epilepticus (NCSE) [1, 4, 5]. Various publications report that 10% of comatose patients suffer from NCSE, being the incidence much higher in the neurocritical care unit (NeuroICU), where about 34% of patients can have altered consciousness [6,7,8,9,10,11]

Methods

Results

Conclusion