Clinical Outcomes Following Prolonged Refractory Status Epilepticus (PRSE)

Kilbride, Ronan; Reynolds, Alexandra S.; Szaflarski, Jerzy P.; Hirsch, Lawrence J.

doi:10.1007/s12028-013-9823-4

Cited by 56 publications

(56 citation statements)

References 12 publications

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“…The authors stress that 10% of these cases of severe refractory SE (defined in this study as ongoing or recurrent SE 24h or more after starting cIVADs) had excellent outcome. This is similar to the conclusion of a recent multicenter study of patients with prolonged refractory SE (ongoing or recurrent SE after at least 1 week of cIVADs), where 14 of 63 patients had good outcome (moderate disability or better) and 6 (10%) had no disability (4).…”

Section: Finding the Lesser Of Two Evils: Treating Refractory Status supporting

confidence: 90%

Finding the Lesser of Two Evils: Treating Refractory Status Epilepticus

Hirsch¹

2015

Epilepsy Curr

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OBJECTIVE: To evaluate the risks of continuously administered IV anesthetic drugs (IVADs) on the outcome of adult patients with status epilepticus (SE). METHODS: All intensive care unit patients with SE from 2005 to 2011 at a tertiary academic medical care center were included. Relative risks were calculated for the primary outcome measures of seizure control, Glasgow Outcome Scale score at discharge, and death. Poisson regression models were used to control for possible confounders and to assess effect modification. RESULTS: Of 171 patients, 37% were treated with IVADs. Mortality was 18%. Patients with anesthetic drugs had more infections during SE (43% vs 11%; p < 0.0001) and a 2.9-fold relative risk for death (2.88; 95% confidence interval 1.45-5.73), independent of possible confounders (i.e., duration and severity of SE, nonanesthetic third-line antiepileptic drugs, and critical medical conditions) and without significant effect modification by different grades of SE severity and etiologies. As IVADs were used after first-and second-line drugs failed, there was a correlation between treatment-refractory SE and the use of IVADs, leading to insignificant results regarding the risk of IVADs and outcome after additional adjustment for refractory SE. CONCLUSION: Our findings heighten awareness regarding adverse effects of IVADs. Randomized controlled trials are needed to further clarify the association of IVADs with outcome in patients with SE. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that patients with SE receiving IVADs have a higher proportion of infection and an increased risk of death as compared to patients not receiving IVADs. INTRODUCTION: Seizures refractory to third-line therapy are also labeled super-refractory status epilepticus (SRSE). These seizures are extremely difficult to control and associated with poor outcome. We aimed to characterize efficacy and side-effects of continuous infusions of pentobarbital (cIV-PTB) treating SRSE. METHODS: We retrospectively reviewed continuous electroencephalography (cEEG) reports for all adults with RSE treated with cIV-PTB between May 1997 and April 2010 at our institution. Patients with post-anoxic SE and those receiving cIV-PTB for reasons other than RSE were excluded. We collected baseline information, cEEG findings, side-effects and functional outcome at discharge and one year. RESULTS: Thirty-one SRSE patients treated with cIV-PTB for RSE were identified. Mean age was 48 years old (interquartile range (IQR) 28,63), 26% (N = 8) had a history of epilepsy. Median SE duration was 6.5 days (IQR 4,11) and the mean duration of cIV-PTB was 6 days (IQR 3,14). 74% (N = 23) presented with convulsive SE. Underlying etiology was acute symptomatic seizures in 52% (N = 16; 12/16 with encephalitis), remote 30% (N = 10), and unknown 16% (N = 5). cIV-PTB controlled seizures in 90% (N = 28) of patients but seizures recurred in 48% (N = 15) while weaning cIV-PTB, despite the fact that suppression-burst was attained in 90% (N = 28) of patients and pers...

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Section: Finding the Lesser Of Two Evils: Treating Refractory Status supporting

confidence: 90%

Finding the Lesser of Two Evils: Treating Refractory Status Epilepticus

Hirsch¹

2015

Epilepsy Curr

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“…Between 31-43% of cases will be refractory to first-line and second-line treatments [5,6], and this subset, termed refractory status epilepticus, has a mortality rate of 30% [7,8]. Common causes of status epilepticus include low antiseizure drug levels (many cases due to drug withdrawal), stroke, and remote central nervous system insults [9], while the etiologies of RSE differ somewhat with encephalitis, and metabolic derangements accounting for a higher percentage of cases in addition to low antiseizure drug levels [7,8]. The management of early status epilepticus is well studied and relies on benzodiazepines [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…The evidence-based reporting outcome of therapies in refractory and super refractory status epilepticus consists entirely of single case reports and small retrospective series [7,8,[14][15][16] and at least one multicenter retrospective study designed to examine the safety and efficacy of ketamine [17]. Two randomized controlled trials have been attempted, and both had to be stopped early because of low enrolment [18,19].…”

Section: Introductionmentioning

confidence: 99%

Preliminary results of the global audit of treatment of refractory status epilepticus

Ferlisi

Hocker

Grade

et al. 2015

Epilepsy & Behavior

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“…In contrast, the risks of mortality53 and neurological deficits are low with febrile SE and cryptogenic/idiopathic SE 26, 27, 28, 72. However, the specific subcategory of presumed encephalitis or new onset refractory SE may be associated with worse long‐term outcome16, 73, 74 and prolonged duration of SE 21…”

Section: Factors Affecting Outcomementioning

confidence: 99%

Long‐term outcomes of status epilepticus: A critical assessment

et al. 2018

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SummaryWe reviewed 37 studies reporting long‐term outcomes after a status epilepticus (SE) episode in pediatric and adult populations. Study design, length of follow‐up, outcome measures, domains investigated (mortality, SE recurrence, subsequent epilepsy, cognitive outcome, functional outcome, or quality of life), and predictors of long‐term outcomes are summarized. Despite heterogeneity in the design of prior studies, overall risk of poor long‐term outcome after SE is high in both children and adults. Etiology is the main determinant of outcome, and the effect of age or SE duration is often difficult to distinguish from the underlying cause. The effect of the treatment on long‐term outcome after SE is still unknown.

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Clinical Outcomes Following Prolonged Refractory Status Epilepticus (PRSE)

Abstract: Good outcome is not unusual in PRSE, including in some older patients, in a variety of diagnoses, and despite months of coma.

Cited by 56 publications

References 12 publications

Finding the Lesser of Two Evils: Treating Refractory Status Epilepticus

Finding the Lesser of Two Evils: Treating Refractory Status Epilepticus

Preliminary results of the global audit of treatment of refractory status epilepticus

Long‐term outcomes of status epilepticus: A critical assessment

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