Dataset Information

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

ABSTRACT:

Objectives

The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.

Methods

Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).

Results

Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes.

Conclusions

Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.

SUBMITTER: Gaspard N

PROVIDER: S-EPMC4642147 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Publications

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Gaspard Nicolas N Foreman Brandon P BP Alvarez Vincent V Cabrera Kang Christian C Probasco John C JC Jongeling Amy C AC Meyers Emma E Espinera Alyssa A Haas Kevin F KF Schmitt Sarah E SE Gerard Elizabeth E EE Gofton Teneille T Kaplan Peter W PW Lee Jong W JW Legros Benjamin B Szaflarski Jerzy P JP Westover Brandon M BM LaRoche Suzette M SM Hirsch Lawrence J LJ

Neurology 20150821 18

<h4>Objectives</h4>The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.<h4>Methods</h4>Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Sc ...[more]

PMID: 26296517

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Project description:OBJECTIVE:Examine the association of duration of therapeutic coma (TC) with seizure recurrence, morbidity, and mortality in refractory status epilepticus (RSE). Define an optimal window for TC that provides sustained seizure control and minimizes complications. METHODS:Retrospective, observational cohort study involving patients who presented with RSE to the University of Alabama at Birmingham or the University of California at San Francisco from 2010 to 2016. Relationship of duration of TC with primary and secondary outcomes was evaluated using two-sample t tests, simple linear regression, and chi-square tests. Multivariable linear and logistic regression models were used to identify independent predictors. Predictive ability of TC for seizure recurrence was quantified using a receiver-operating characteristic curve. Youden index was used to determine an optimal cutoff value. RESULTS:Multivariable analysis of clinical and treatment characteristics of 182 patients who were treated predominantly with propofol as anesthetic agent showed that longer duration of the first trial of TC (27.2 vs 15.6 hours) was independently associated with a higher chance of seizure recurrence following the first weaning attempt (P = 0.038) but not with poor functional neurologic outcome upon discharge, in-hospital complications, or mortality. Furthermore, higher doses of anesthetic utilized during the first trial of TC were independently associated with fewer in-hospital complications (P = 0.003) and associated with a shorter duration of mechanical ventilation and total length of stay. Duration of TC was identified as an independent predictor of seizure recurrence with an optimal cutoff point at 35 hours. SIGNIFICANCE:This study suggests that a shorter duration yet deeper TC as treatment for RSE may be more effective and safer than the currently recommended TC duration of 24-48 hours. Prospective and randomized trials should be conducted to validate these assertions.

Dataset Information

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Objectives

Methods

Results

Conclusions

Publications

New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Similar Datasets

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