Functional Outcomes of Refractory Status Epilepticus and Super-refractory Status Epilepticus in Specific Etiologies
Vasinee Viarasilpa1, Anutr Khummongkol1, Theeradej Tepkasetkul1, Sattawut Wongwiangiunt1, Kanokwan Boonyapisit1
1Neurology, Internal medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Objective:
This study aimed to evaluate the short-term and long-term functional outcomes of patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) across specific etiologies.
Background:
RSE and SRSE are associated with high morbidity and mortality, with etiology being the most critical determining factor.
Design/Methods:
Retrospective study of patients aged over 18 years with RSE and SRSE. Demographics, etiology, Modified Rankin Scale (mRS) at 0, 3-, 6-, 12-, and 24 months after discharge were assessed. Chi-Square tests and Kaplan-Meier curve were used for analysis.
Results:
A total of 457 patients were categorized by etiology: 206 (45.1%) structural lesion, 108 (23.6%) metabolic derangement, 65 (14.2%) hypoxic ischemic encephalopathy due to postcardiac arrest, 37 (8.1%) central nervous system (CNS) infection, 14 (3.1%) subtherapeutic antiseizure medication (ASM) levels, 13 (2.8%) autoimmune encephalitis, 12 (2.6%) unknown etiology, and 2 (0.4%) genetic diseases. The mortality rate at discharge was highest in postcardiac arrest group (83.1%), followed by CNS infection group (56.8%), and metabolic derangement group (45.4%), p<0.001. Structural group had significantly higher percentage of patients with bed-bound status at discharge (33.5%, p<0.001). Patients in subtherapeutic ASM levels group demonstrated the highest rate of functional independent at discharge (43.8%, p<0.001). For long-term outcome, we tracked the progression of mRS scores of patients in each etiology up to 24 months. The majority of patients (83.1%) in postcardiac arrest group experienced in-hospital mortality. The percentage of survivors had stabilized for all etiologies by the third month post-discharge.
Conclusions:
This large cohort study evaluated the outcomes of RSE and SRSE across specific etiologies up to 24 months post-discharge. RSE and SRSE due to postcardiac arrest had the poorest short-term outcomes (mRS 6). By the third month, the percentage of survivors had stabilized for all etiologies.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.