Abstracts

Rationale: Super refractory status epilepticus (SRSE) is a relatively new term used to describe status epilepticus that continues for 24 hours or more despite treatment with anesthetic antiepileptic drugs.  The goal of this study was to determine the epidemiology, etiology, and clinical outcomes of SRSE cases at a single academic tertiary care center over a 10 year period. Methods: We performed a hospital-based retrospective review of all patients admitted from 2007 through 2016 who underwent prolonged continuous video EEG monitoring for 4 or more days. Results: Among the 358 patients who met inclusion criteria, 67 cases were identified as SRSE.  10 cases were due to pre-existing epilepsy, 44 cases were symptomatic (37 acute and 7 remote symptomatic etiologies), and 13 cases were due to NORSE (New-Onset Super-Refractory Status Epilepticus).  The NORSE group was different from the other two groups in younger age (average 44), majority female (69%) and longer duration of admission (42 days).  In the NORSE patients, autoimmune or paraneoplastic antibodies were identified in seven patients. Eleven received steroids. In addition, nine received further immunomodulation with IVIG, PLEX, and/ or rituximab. A small number (four) received electroconvulsive shock therapy or underwent induction with ketogenic diet (two). Consistent with previous documented reports of high mortality in those with SRSE, we found an overall mortality of 39%. Due to the small numbers of this rare but devastating disorder, we are unable to describe statistically significant differences in clinical outcomes between different treatment modalities Conclusions: In summary, we describe the epidemiology and treatments of SRSE in a single tertiary care center; larger multicenter collaborations are critical to further understanding the epidemiology and optimal treatment of SRSE. Funding: None