Abstracts

Rationale: Status Epilepticus (SE) is a commonly encountered medical emergency, and a significant percentage of these patients prove refractory to first- and second-line anticonvulsant therapies. Prolonged Refractory SE (PRSE), SE that persists despite ?7 days of continuous anesthetic infusion, represents a rarer subset of SE, but familiar to Neuro Intensive Care Units. We sought to better define this clinical entity and to describe treatment outcomes.Methods: Three academic centers systematically identified patients with PRSE(excluding cardiac arrest) by review of records from 2001 to 2010. Clinical, neurophysiologic and imaging data were investigated in relation to outcomes. Modified Rankin Scores (MRS) at discharge, 6 months and most recent follow-up (when available) were assessed. Recurrence of SE and seizure control was considered.Results: Sixty-three patients, 26 male and 37 females (age 14 to 86 yr), were identified with PRSE (SE duration 8 to 169 days). Thirty-one of 42 patients in PRSE for 8 to 30 days survived to discharge. At 6 months 5 of these were known to have only moderate disability and ambulated with out assistance (MRS 3) or better. In patients with PRSE lasting 30 to 59 days, 6 of 13 survived to discharge, of which 5 had a MRS of 3 or better at 6 months. In 4 patients treated for PRSE of 60-89 days, all survived to discharge and had confirmed follow up at 6 months, 3 of 4 with an MRS of 3 or better. One of 3 patients in PRSE >90 days survived to discharge, with a MRS of 5 (PVS), at 6 months. The longest course of PRSE, within our cohort, with a MRS ?3 at 6 months was 79 days. The mean age of survivors of PRSE was slightly less than those who died (41 vs 49 yr). Eighteen of 24 patients under age 30 survived to discharge, of whom 8 were confirmed to have an MRS ?3 at 6 months. Of 7 patients aged 30-39, 6 survived to discharge, however all with stated MRS of 5 at that time and only one patient had a confirmed MRS ?3 at 6 months. All 5 patients aged 40-49 survived to discharge, but only 1 had a confirmed MRS ?3 at 6 months. Two of 9 patients aged 50-59 survived to discharge, 1 of whom had confirmed follow up at 6months, 1 with a MRS ?3. In patients with PRSE aged 60-69, 5 of 10 survived to discharge, 2 of which had MRS ?3 at 6 months. Six of 8 patients aged 70 or older survived to discharge from acute hospitalization; however none had a confirmed MRS ?3 at 6 months. The oldest patient with a MRS ?3 at 6 months in our cohort was 69 years old with only slight disability, and was able to manage their own affairs. Seizure outcome data was available in 26 patients. At 6 months 18 had multiple or refractory seizures and 8 were seizure free. All continued on AED therapy at 6 months, 1 patient successfully withdrew from AED therapy at last know follow up.Conclusions: PRSE remains a clinically challenging entity. Patients of all ages and protracted SE durations can survive this entity, many with reasonably good outcome and some without refractory epilepsy few if any seizures. Further prospective multi-center cooperation will be needed to best establish optimal therapies for this severe form of SE.