Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Cornwall, Camilla Dyremose; Krøigård, Thomas; Kristensen, Joachim Sejr Skovbo; Edemann-Callesen, Henriette; Beier, Christoph P.

doi:10.1001/jamaneurol.2023.2407

Cited by 11 publications

(10 citation statements)

References 68 publications

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“…In this study, 50 SRSE patients received phenobarbital of whom only one patient failed treatment. The result was slightly different from the current meta-analysis 15 which revealed that phenobarbital revealed a nonsignificant trend toward worse outcomes at discharge. Based on this study, we suggested that phenobarbital might benefit the patients by the high prevalence of seizure control.…”

Section: Discussioncontrasting

confidence: 99%

“…The whole mortality rate was similar to that reported previously. In the recently published meta-analysis, 15 the in-hospital mortality in SRSE patients was 24.1%. In this study, the mortality of in-hospital mortality and 6 months after discharge in the SRSE group were 11.8% and 31.4%, respectively.…”

Section: Discussionmentioning

confidence: 98%

“…In the current study, we found that GCSE triggered by autoimmune encephalitis or intracranial infection was prone to SRSE, which is consistent with previous findings. [13][14][15] Shorvon 4 concluded that the etiology of SRSE is a severe acute brain injury. Tian et al 13 showed that acute encephalitis is a critical etiology of SRSE.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, in another study, 14 a cohort of SRSE also showed encephalitis as the most common etiology and a major factor in the progress from non-refractory SE to SRSE. A recently published meta-analysis of SRSE 15 revealed that in SRSE patients, acute cerebral events (including acute stroke, intracerebral hemorrhages, infectious disease, and autoimmune encephalitis) and unknown etiologies accounted for 41.6% and 22.3% of all etiologies, respectively. In this study, the percentage of autoimmune encephalitis and intracranial infections accounted for a quite high percentage in the SRSE group with patients’ bias.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Wang,

Li,

Pan

et al. 2023

Ther Adv Neurol Disord

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Background: Generalized convulsive status epilepticus (GCSE) is one of the most challenging life-threatening neurological emergencies. If GCSE becomes super-refractory, it is associated with significant mortality. Although aggressive management of prolonged status epilepticus was conducted, the mortality has not decreased since the late 1990s. Objectives: The present study aimed to explore the risk factors for progression to super-refractory in patients with generalized convulsive status epilepticus (GCSE). Moreover, we illustrated the risk factors for mortality in GCSE patients. Design: An observational retrospective cohort study. Methods: We conducted a retrospective study of patients with GCSE admitted to our neurocritical unit, in Guangzhou, China, from October 2010 to February 2021. The data of sociodemographic information, etiology, laboratory results, treatment, and prognosis were collected and analyzed. Results: A total of 106 patients were enrolled; 51 (48%) of them developed super-refractory status epilepticus (SRSE). Multivariate logistic regression analysis demonstrated that patients with autoimmune encephalitis ( p = 0.015) and intracranial infection ( p = 0.019) are likely to progress to SRSE. The in-hospital mortality was 11.8% and 9.1% for patients in the SRSE and non-SRSE groups, respectively ( p = 0.652). Multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratios (NLR) at admission were independently associated with in-hospital mortality. Up to 31.4% of SRSE patients and 29.1% of non-SRSE patients died within 6 months after discharge ( p = 0.798). Multivariate logistic regression analysis showed that plasma exchange (PE) was a protective factor for 6-month mortality. A high NLR at discharge was a risk factor for 6-month mortality. Conclusion: In the current study, about 48% of GCSE patients progressed to SRSE. Regarding etiology, autoimmune encephalitis or intracranial infection was prone to SRSE. No significant differences were observed in the in-hospital and 6-month mortality between SRSE and non-SRSE groups. Multivariate logistic regression analysis showed that NLR at admission and discharge was an independent predictor of in-hospital and 6-month mortality, respectively. Moreover, PE significantly reduced the 6-month mortality.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Wang,

Li,

Pan

et al. 2023

Ther Adv Neurol Disord

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“…Of note, in our study, SRSE was not significantly associated with an overall increased risk of RS, but when RS occurred, the risk of develop DRE was higher. From this point of view, it is worth noting that mortality is high in the case of SRSE and survivors are left with severe disabilities [44]. Therefore, patients with SRSE may have died prior to experience unprovoked seizures, but once it occurred, post-SE epilepsy was drug-resistance in the majority of cases (5/6 patients).…”

Section: Post-se Drementioning

confidence: 99%

Remote seizures and drug‐resistant epilepsy after a first status epilepticus in adults

Orlandi,

Giovannini,

Cioclu

et al. 2024

Euro J of Neurology

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Background and purposeLong‐term consequences after status epilepticus (SE) represent an unsettled issue. We investigated the incidence of remote unprovoked seizures (RS) and drug‐resistant epilepsy (DRE) in a cohort of first‐ever SE survivors.MethodsA retrospective, observational, and monocentric study was conducted on adult patients (age ≥ 14 years) with first SE who were consecutively admitted to the Modena Academic Hospital, Italy (September 2013–March 2022). Kaplan–Meier survival analyses were used to calculate the probability of seizure freedom following the index event, whereas Cox proportional hazard regression models were used to identify outcome predictors.ResultsA total of 279 patients were included, 57 of whom (20.4%) developed RS (mean follow‐up = 32.4 months). Cumulative probability of seizure freedom was 85%, 78%, and 68% respectively at 12 months, 2 years, and 5 years. In 45 of 57 patients (81%), the first relapse occurred within 2 years after SE. The risk of RS was higher in the case of structural brain damage (hazard ratio [HR] = 2.1, 95% confidence interval [CI] = 1.06–4.01), progressive symptomatic etiology (HR = 2.7, 95% CI = 1.44–5.16), and occurrence of nonconvulsive evolution in the semiological sequence of SE (HR = 2.9, 95% CI = 1.37–6.37). Eighteen of 57 patients (32%) developed DRE; the risk was higher in the case of super‐refractory (p = 0.006) and non‐convulsive SE evolution (p = 0.008).ConclusionsThe overall risk of RS was moderate, temporally confined within 2 years after the index event, and driven by specific etiologies and SE semiology. Treatment super‐refractoriness and non‐convulsive SE evolution were associated with DRE development.

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Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

Bode,

Kristensen,

Olsen

et al. 2023

Neurocrit Care

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Background Postictal encephalopathy is well known after status epilepticus (SE), but its prognostic impact and triggers are unknown. Here, we aimed to establish risk factors for the development of postictal encephalopathy and to study its impact on survival after discharge. Methods This retrospective cohort study comprised adult patients diagnosed with first nonanoxic SE at Odense University Hospital between January 2008 and December 2017. Patients with ongoing SE at discharge or unknown treatment success were excluded. Postictal symptoms of encephalopathy were estimated retrospectively using the West Haven Criteria (WHC). WHC grade was determined for postictal day 1 to 14 or until the patient died or was discharged from the hospital. Cumulative postictal WHC during 14 days after SE-cessation was used to quantify postictal encephalopathy. Clinical characteristics, patient demographics, electroencephalographic and imaging features, and details on intensive care treatment were assessed from medical records. Results Of all eligible patients (n = 232), 198 (85.3%) had at least WHC grade 2 postictal encephalopathy that lasted for > 14 days in 24.5% of the surviving patients. WHC grade at discharge was strongly associated with poor long-term survival (p < 0.001). Postictal encephalopathy was not associated with nonconvulsive SE, postictal changes on magnetic resonance imaging, or distinct ictal patterns on electroencephalography. Although duration of SE and treatment in the intensive care unit showed an association with cumulative postictal WHC grade, they were not independently associated with the degree of encephalopathy when controlling for confounders. In a linear regression model, etiology, duration of sedation, age, and premorbid modified Rankin Scale were significant and consistent predictors for higher cumulative postictal WHC grade. Exploratory analyses showed an association of a cumulative midazolam dosage (mg/kg/h) with higher cumulative postictal WHC grade. Discussion In this cohort, postictal encephalopathy after SE was common and associated with poor long-term survival. Seizure characteristics were not independently associated with postictal encephalopathy; the underlying etiology, long (high-dose midazolam) sedation, high age, and poor premorbid condition were the major risk factors for its development.

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Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Cited by 11 publications

References 68 publications

Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Remote seizures and drug‐resistant epilepsy after a first status epilepticus in adults

Postictal Encephalopathy After Status Epilepticus: Outcome and Risk Factors

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