Predictors of outcome in super refractory status epilepticus

Jose, Jithu; Keni, Ravish R.; Hassan, Haseeb; Menon, Ramshekhar; Sukumaran, Sajith; Cherian, Ajith; Radhakrishnan, Ashalatha

doi:10.1016/j.yebeh.2021.107929

Cited by 5 publications

(3 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 309 were included for full-text evaluation, leading to the final inclusion of 95 studies (60 case reports, 2 interventional studies, and 33 case-control/cohort studies; for references see eTable 1 and 2 in Supplement 1 and a list of excluded studies is given in eTable 3 in Supplement 1), and 30 conference abstracts (n = 1200 reported patients). The study team identified 26 studies describing cohorts with 10 or more patients (data set 1, n = 1031 patients; Figure 1) and 104 studies describing individual patient data in sufficient detail (data set 2, n = 266 patients; Figure 1). The data sets partly overlapped and 97 patients were included in both.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

et al. 2023

View full text Add to dashboard Cite

ImportanceSuper-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthetic therapy or recurs on the reduction/withdrawal of anesthesia. Current clinical knowledge of the disease and optimal treatment approach is sparse.ObjectiveTo systematically assess clinical characteristics, causes, outcomes, prognostic factors, and treatment approaches for patients with SRSE.Design, Setting, and ParticipantsIn this systematic review and meta-analysis, all studies reporting adult patients (18 years or older) diagnosed with nonanoxic SRSE were considered for inclusion, irrespective of study design. The databases used were MEDLINE, Cochrane Library, EMBASE, and ClinicalTrials.org (database inception through May 5, 2022).Data extraction and synthesisThe study complied with the PRISMA guidelines for reporting, data extraction, and data synthesis. Different tools were used to assess risk of bias. All available data were extracted and missing data were neither imputed nor completed by contacting the study authors.Main outcome and measuresSuccessful treatment of SRSE, in-hospital mortality, and disability at discharge (estimated modified Rankin Scale).ResultsThe study team identified a total of 95 articles and 30 conference abstracts reporting 1200 patients with nonanoxic SRSE (266 individual patients were available for meta-analysis). They had a mean SRSE duration of 36.3 days, mean age of 40.8 years, and equal sex distribution. Patients with SRSE had a distinct pattern of etiologies where acute cerebral events and unknown etiologies accounted for 41.6% and 22.3% of all etiologies, respectively. Reports of SRSE caused by, eg, alcohol, drugs, or tumors were rare. At discharge, only 26.8% had none to slight disability (none, 16 [8.4%]; nonsignificant and slight disability, 35 [18.4%]). In-hospital mortality was 24.1%. Mortality stabilized after long-term treatment (more than 28 days) but with increased rates of seizure cessation and moderate to severe disability. Established prognostic factors, such as age and etiology, were not associated with in-hospital mortality. Reported treatment with ketamine, phenobarbital, other barbiturates, vagus nerve stimulator, and ketogenic diet were not associated with outcome.Conclusion and RelevancePatients with SRSE are distinct due to their pattern of care (eg, long-term treatment to younger patients without negative prognostic factors and unknown/nonmalignant etiologies) and their natural course of SE. Very long-term treatment was associated with lower mortality and high odds of cessation of SRSE but increased risk of moderate to severe disability.

show abstract

Section: Resultsmentioning

confidence: 99%

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

et al. 2023

View full text Add to dashboard Cite

show abstract

“…16 However, spontaneous burst suppression and postictal background attenuation were independent predictors of poor outcome (Glasgow outcome score [GOS] < 3 at hospital discharge). 17 Additionally, some EEG features have been shown to predict transition from generalized convulsive SE to RSE, including abundant interictal epileptiform discharges (>1 per 10 seconds) and periodic discharges up to 2 Hz in frequency, when seen up to 6 hours following firstand second-line treatment. 18 cEEG monitoring is also essential for guiding the wean of anesthetic medications following control of RSE and super RSE (SRSE), although data on predictors of successful anesthetic withdrawal are scarce.…”

Section: Eeg Features Of Prognostication In the Acute Critically Ill ...mentioning

confidence: 99%

Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury

Rubinos,

Bruzzone,

Viswanathan

et al. 2023

Semin Neurol

View full text Add to dashboard Cite

Electroencephalography (EEG) is a noninvasive tool that allows the monitoring of cerebral brain function in critically ill patients, aiding with diagnosis, management, and prognostication. Specific EEG features have shown utility in the prediction of outcomes in critically ill patients with status epilepticus, acute brain injury (ischemic stroke, intracranial hemorrhage, subarachnoid hemorrhage, and traumatic brain injury), anoxic brain injury, and toxic-metabolic encephalopathy. Studies have also found an association between particular EEG patterns and long-term functional and cognitive outcomes as well as prediction of recovery of consciousness following acute brain injury. This review summarizes these findings and demonstrates the value of utilizing EEG findings in the determination of prognosis.

show abstract

“…However, some patients have good outcomes, even after prolonged status epilepticus, so patients need prompt examination and treatment [13]. Current mainstays of treatment include sedatives and antiseizure medications combined with other treatment modalities, including a ketogenic diet [14]. Although the evidence is limited, early attempts to alter the putative underlying pathogenesis through immune modulation are appropriate, and recent studies have found that interleukin inhibitors can be used [15].…”

Section: Introductionmentioning

confidence: 99%

New-Onset Refractory Status Epilepticus Caused by Autoimmune Encephalitis May Have a Better Prognosis than when due to Other Causes

Zhang,

Wang

et al. 2024

Acta Neurologica Scandinavica

View full text Add to dashboard Cite

Objective. To explore whether the new-onset refractory status epilepticus caused by autoimmune encephalitis has a better prognosis. Methods. This retrospective observational study enrolled patients with NORSE who were admitted from January 2015 to February 2024. The clinical data and clinical outcomes of the patients were collected and analyzed, and the primary outcome was seizures still at follow-up. Statistical analyses were performed using SPSS software V.22.0. Results. Among the 42 patients with NORSE, 15 (35.7%) had autoimmune encephalitis (AE), 3 (7.1%) patients had central nervous system infections, 24 (57.1%) patients had an unknown etiology, and 4 (9.5%) patients died in the hospital. Modified Rankin scale (MRS) scores at discharge of NORSE patients in the autoimmune encephalitis group and non-AE group were compared (P=0.339). After 4 years of follow-up, analysis of patients who still had seizures showed that the only risk factor was etiology and that patients with nonautoimmune encephalitis etiology were more prone to later epilepsy (P=0.030 (OR=16.767, 95% CI: 1.454-213.395)). The MRS scores of the AE group and non-AE group were compared (P≤0.001), with the autoimmune group having a better functional outcome. Significance. The overall prognosis of patients with autoimmune encephalitis may be better than that of patients with other etiologies, and later epilepsy is more likely in patients with nonautoimmune encephalitis. However, this result requires further validation in larger studies with more data.

show abstract

Predictors of outcome in super refractory status epilepticus

Cited by 5 publications

References 30 publications

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Electroencephalography as a Biomarker of Prognosis in Acute Brain Injury

New-Onset Refractory Status Epilepticus Caused by Autoimmune Encephalitis May Have a Better Prognosis than when due to Other Causes

Contact Info

Product

Resources

About