Neuropsychological Outcomes in the Aftermath of New-Onset and Super-Refractory Status Epilepticus
Hannah Gray1, Karnig Kazazian2, Alexandre De Almeida Castro3, Bahar Madani4, Anima Shrestha5, Krista Eschbach5, Margaret Gopaul6, Aurelie Hanin6, Lawrence Hirsch7, Marissa Kellogg8, Ana Suller Marti9, Teneille Gofton9
1Neuroscience, Western University, 2Western University, 3Yale University, 4Oregon Health & Science University, 5Children's Hospital Colorado, 6Yale University School of Medicine, 7Yale University Comprehensive Epilepsy Center, 8VA Portland Healthcare System, Dept of Neurology, 9London Health Sciences Centre
Objective:
To describe long-term neuropsychological and clinical outcomes of new-onset refractory status epilepticus (NORSE) and super-refractory status epilepticus (SRSE) survivors.
Background:
Long-term neuropsychological sequelae in NORSE/SRSE survivors are under-explored, partly due to the brevity of assessments that are commonly used. This impacts patient care and limits clinicians’ ability to predict outcomes. More robust evidence is needed to better define the neuropsychological profile of NORSE/SRSE survivors, and to further elucidate clinical factors that may be related to neuropsychological outcomes.
Design/Methods:
This is a multi-site retrospective study, involving one Canadian and three American sites. People with SRSE (with or without NORSE) from 2000 to 2023 with subsequent clinical neuropsychological evaluations were enrolled. Neuropsychological outcomes were organized based on the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE). Accordingly, data was organized for presented analyses into generalized impairment (impairment in at least three domains) and less than generalized impairment. Clinical factors were gathered from medical records.
Results:
Among the 20 participants (13 adult, seven pediatric; 10 females), 14 were generally impaired, two bi-domain impaired, and three single-domain impaired, and one participant had intact cognition. No associations were found between IC-CoDE classifications and sex, age at Intensive Care Unit (ICU) admission, adult versus pediatric, age at time of neuropsychological testing, or time since ICU discharge. Regarding specific domains, 18 were impaired in memory, 14 in executive functioning, 13 in language, 12 in attention and processing speed, and six in visuospatial abilities. Post-SE, 17 participants developed epilepsy. The mean time between ICU admission and time of neuropsychological testing was 3.25 years. Data collection is ongoing; the most up-to-data, including a comparison of the neuropsychological assessments implemented across sites, will be presented.
Conclusions:
This study details the long-term neuropsychological outcomes of NORSE/SRSE survivors. Sites’ methods of long-term clinical care and assessment, and various patient outcomes may inform recommendations for clinical care.
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