Recovery after severe refractory status epilepticus and 4 months of coma

Bausell, R. Barker; Svoronos, Alexandra; Lennihan, Laura; Hirsch, Lawrence J.

doi:10.1212/wnl.0b013e318232abc0

Cited by 28 publications

(15 citation statements)

References 4 publications

(5 reference statements)

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“…Cryptogenic new-onset refractory status epilepticus (NORSE) describes a group of previously healthy adults who present with refractory prolonged SE without known aetiology (Gall et al, 2013;Wilder-Smith et al, 2005), as in our patients. Patients with NORSE have prodromal symptoms before SE and often are suspected to have viral encephalitis (Bausell et al, 2011). Accumulating evidence supports that autoimmune aetiology may be the underlying cause of NORSE, and immunotherapy may bring about better outcome (Gall et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Mega‐dose phenobarbital therapy for super‐refractory status epilepticus

Byun

Chu

Sunwoo

et al. 2015

Epileptic Disorders

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Aims. To evaluate the efficacy and safety of mega‐dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super‐refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients. Methods. Adult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events. SRSE outcome was divided into six categories: successful therapy, initial failure, breakthrough seizures, withdrawal seizures, intolerable side effects, and death during treatment. Results. Ten adult patients with SRSE received MDPB. Median age at seizure onset was 38 years (range: 18‐59), and half were male. All patients had no history of seizures and had symptoms suggestive of viral encephalitis. Median duration of status epilepticus was 17.5 days (range: 6–60) and anaesthetics were used for a median of 14.0 days (range: 2–54) before MDPB. Successful control of SRSE was achieved in half of the patients, however, only one of ten patients was able to fully recover at discharge. Median duration of the MDPB was 45.5 days and the maximum serum phenobarbital level reached a median of 151.5 μg/ml. Patients with successful MDPB therapy had normal brain imaging (80% vs. 0%; p=0.048) and better functional outcome at discharge and after three months of follow‐up. Infection was the most critical complication, along with cardiorespiratory depression. Conclusion. MDPB is a therapeutic option for control of SRSE when other choices are exhausted.

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Section: Discussionmentioning

confidence: 99%

Mega‐dose phenobarbital therapy for super‐refractory status epilepticus

Byun

Chu

Sunwoo

et al. 2015

Epileptic Disorders

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“…We found 14 adult cases of SRSE with detailed clinical descriptions (Bausell et al, 2011;Finné Lenoir et al, 2013;Fugate et al, 2010;Hocker et al, 2014;Johnson et al, 2010;Kanter et al, 2008;Kondziella et al, 2008;Krishnamurthy and Drislane, 1997;Mirski et al, 1995;Moseley and Degiorgio, 2014;Prüss and Holtkamp, 2008;Robakis and Hirsch, 2006;Standley et al, 2012;Thordstein and Constantinescu, 2012) (see Table 3). Almost all of these patients were young (27 year-old; range, 17-68).…”

Section: Case Reports Of Prolonged Super Refractory Status Epilepticumentioning

confidence: 93%

Is Favorable Outcome Possible After Prolonged Refractory Status Epilepticus?

Alvarez

Drislane

2016

Journal of Clinical Neurophysiology

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When status epilepticus (SE) remains refractory to appropriate therapy, it is associated with high mortality and with substantial morbidity in survivors. Many outcome predictors such as age, seizure type, level of consciousness before treatment, and mostly, etiology, are well-established. A longer duration of SE is often associated with worse outcome, but duration may lose its prognostic value after several hours. Several terms and definitions have been used to describe prolonged, refractory SE, including "malignant SE," "prolonged" SE, and more recently, "super refractory" SE, defined as "SE that has continued or recurred despite 24 hours of general anesthesia (or coma-inducing anticonvulsants)." There are few data available regarding the outcome of prolonged refractory SE, and even fewer for SE remaining refractory to anesthetic drugs. This article reviews reports of outcome after prolonged, refractory, and "super refractory" SE. Most information detailing the clinical outcome of patients surviving these severe illnesses, in which seizures can persist for days or weeks (and especially those concerning "super-refractory" SE) come from case reports and retrospective cohort studies. In many series, prolonged, refractory SE has a mortality of 30% to 50%, and several studies indicate that most survivors have a substantial decline in functional status. Nevertheless, several reports demonstrate that good functional outcome is possible even after several days of SE and coma induction. Treatment of refractory SE should not be withdrawn from younger patients without structural brain damage at presentation solely because of the duration of SE.

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“…39 One caveat is that patients with new-onset RSE can show satisfactory recovery after SE, even after several weeks to months of prolonged coma. 54,55 All studies on the role of seizure duration are hampered, however, by the inevitable approximation of seizure duration.…”

Section: Duration Of Status Epilepticusmentioning

confidence: 99%

Outcome predictors for status epilepticus—what really counts

2013

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In adult patients with status epilepticus (SE)-a life-threatening state of ongoing or repetitive seizures--the current evidence regarding outcome prediction is based on clinical, biochemical and EEG determinants. These predictors of outcome involve clinical features such as age, history of prior seizures or epilepsy, SE aetiology, level of consciousness, and seizure type at SE onset. The clinical risk-benefit calculation between the danger of undertreated persistent seizure activity and, conversely, the potential damage from unwarranted aggressive treatments remains a constant challenge. Improved knowledge of outcome determinants, as well as increased availability of reliable outcome prediction models early in the course of SE, is paramount for optimization of treatment of patients who develop this disorder. In this Review, we discuss the major prognostic determinants of outcome in SE. Through consideration of studies that provide measures of association between predictors of SE outcome and death, we propose a detailed--but as yet unvalidated--paradigm for assessment of these predictors during the course of SE. Such an algorithm could guide the organization of results from existing trials and provide direction with regard to the parameters that should be monitored in future studies of SE.

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Recovery after severe refractory status epilepticus and 4 months of coma

Cited by 28 publications

References 4 publications

Mega‐dose phenobarbital therapy for super‐refractory status epilepticus

Mega‐dose phenobarbital therapy for super‐refractory status epilepticus

Is Favorable Outcome Possible After Prolonged Refractory Status Epilepticus?

Outcome predictors for status epilepticus—what really counts

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