Most refractory status epilepticus patients have poor functional outcome

Three-quarters of refractory status epilepticus (RSE) patients have a poor functional outcome, which is linked to drug-induced coma and severe encephalographic suppression, say US scientists.

The team, led by Sara Hocker, from the Mayo Clinic in Rochester, Minnesota, USA, also comments: "Cardiopulmonary complications are common and increase the risk of mortality and poor functional recovery, but outcome is primarily dependent on the success or failure of aborting the seizures.

"Once non-anoxic status epilepticus becomes refractory, the clinical course and outcome of the patient are determined by the severity of the status epilepticus."

The researchers identified 63 consecutive episodes of RSE (defined as generalized convulsive or nonconvulsive status epilepticus that continues despite initial first- and second-line therapies) that occurred in 54 patients between 1999 and 2011.

In all, 87.3% of episodes required anesthetic agents, and the mean duration of anesthetic coma was 11.0 days. Furthermore, 90.5% of episodes needed mechanical ventilation. The mean hospital stay was 27.7 days and in-hospital mortality occurred in 31.8% of cases.

The results, published in the Archives of Neurology, indicate that functional outcome was poor (defined as modified Rankin scale [mRS] score of ≥4) in 76.2% of cases, which was preceded by transition to palliative care in 80.0% of cases. Functional decline (defined as change in mRS score of ≥1 from admission to discharge) occurred in 37 episodes, while premorbid functional status was preserved in eight episodes.

Among the survivors, 13 showed improvement, while 13 patients underwent decline and the condition of six patients remained unchanged. Of the 13 patients who showed improvement in their condition, nine changed from poor to good functional outcome.

Seizure control without suppression-burst or isoelectric electroencephalogram predicted good functional recovery. The need for intervention to treat cardiac arrhythmias, recorded in 14 patients, was correlated with poor functional outcome, as was prolonged hospital length of stay and the presence of pneumonia, seen in 39 cases.

Longer duration of mechanical ventilation was linked to in-hospital death. However, the choice of anesthetic drug, the presence of hypoxia or hypotension, and acid-base disturbances were unrelated to functional outcome.

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