Journal
EPILEPSIA
Volume 54, Issue 3, Pages 502-511Publisher
WILEY
DOI: 10.1111/epi.12064
Keywords
Refractory status epilepticus; Mortality; Hypoxic encephalopathy; Brain tumor; Neurocritical care
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Funding
- University of Basel
- Scientific Society Basel
- Gottfried Julia Bangerter-Rhyner Foundation
- UCB
- GlaxoSmithKline
- Janssen-Cilag
- Swiss National Science Foundation
- Swiss Parkinson's Disease Society
- Gossweiler Foundation
- Mach-Gaensslen Foundation
- Botnar Foundation
- Novartis Foundation
- Novartis
- Roche
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Purpose Refractory status epilepticus (RSE) is a life-threatening neurologic emergency with high mortality and morbidity. The aim of this study was to identify and quantify associations between clinical characteristics of adult RSE patients and outcome. Methods Comprehensive medical chart review was performed of all consecutive adult RSE patients treated on the intensive care units of an academic tertiary care center between 2005 and 2011. Demographics, RSE etiologies and duration, comorbidities, as well as outcomes were assessed. Associations between clinical characteristics and death were quantified. Key Findings Of 260 patients with status epilepticus, 111 developed RSE. Hypoxic encephalopathy (23%), brain tumors (14%), known and uncontrolled epilepsy (10%), and ischemic stroke (8%) were the main etiologies. During hospitalization 38% of patients died. Hypoxic encephalopathy (HE) and brain tumors were independently associated with death (relative risk [RR] 2.41, 95% confidence interval [CI] 1.404.12; p=0.001 and RR 2.81, 95%CI 1.594.96; p<0.0001). The estimated hazard ratio of death was 3.1 (95% CI1.66.0; p=0.001) for patients with HE and 1.1 (95% CI 0.52.3; p=0.745) for patients with brain tumors. RSE duration and nonconvulsive status epilepticus in coma were independently associated with death (for every hour RR 1.001; 95%CI 1.001.002; p=0.011 and RR 3.62; 95%CI 1.349.77; p=0.005). Significance Brain tumors and HE had high relative risks for death and were independently associated with mortality in our cohort of critically ill RSE patients. Other clinical characteristics, as well as the use of intravenous anesthetic drugs and mechanical ventilation, may not be strongly related to outcome and should therefore be used cautiously for informed decision making regarding treatment.
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