Short-and Long-Term Outcomes after Status Epilepticus

Refractory Status Epilepticus Frequency, Risk Factors, and Impact on Outcome Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons B-F Arch Neurol 2002;59:205–210 Refractory status epilepticus (RSE) is a life-threatening condition in which seizures do not respond to first- and second-line anticonvulsant drug therapy. How often RSE occurs, risk factors that predispose to this condition, and the effect of failure to control seizures on clinical outcome are poorly defined. Objective To determine the frequency, risk factors, and impact on outcome of RSE. Design Retrospective cohort study. Setting Large academic teaching hospital. Patients Consecutive sample of 83 episodes of status epilepticus in 74 patients (mean age, 63 years). Main outcome. Methods Refractory status epilepticus was defined as seizures lasting longer than 60 minutes despite treatment with a benzodiazepine and an adequate loading dose of a standard intravenous anticonvulsant drug. Factors associated with RSE were identified using univariate and backward stepwise logistic regression analyses. Results In 57 episodes (69%), seizures occurred after treatment with a benzodiazepine, and in 26 (31%), seizures occurred after treatment with a second-line anticonvulsant drug (usually phenytoin), fulfilling our criteria for RSE. Nonconvulsive SE (P = .03) and focal motor seizures at onset (P = .04) were identified as independent risk factors for RSE. Eleven (42%) of 26 patients with RSE had seizures after receiving a third-line agent (usually phenobarbital). Although mortality was not increased (17% overall), RSE was associated with prolonged hospital length of stay (P < .001) and more frequent functional deterioration at discharge (P = .02). Conclusions Refractory status epilepticus occurs in approximately 30% of patients with SE and is associated with increased hospital length of stay and functional disability. Nonconvulsive SE and focal motor seizures at onset are risk factors for RSE. Randomized controlled trials are needed to define the optimal treatment of RSE. Long-term Mortality After a First Episode of Status Epilepticus Logroscino G, Hesdorffer DC, Cascino GD, Annegers JF, Bagiella E, Hauser WA Neurology 2002;58:537–541 Objective To evaluate long-term mortality among people with status epilepticus (SE). Methods The authors performed a population-based retrospective cohort study to determine long-term mortality after SE. Between January 1, 1965, and December 31, 1984, all first ep