Outcomes in 140 critically ill patients with status epilepticus

Despite recent management guidelines, no recent study has evaluated outcomes in ICU patients with status epilepticus (SE).

An 8-year retrospective study.

Observational study in 140 ICU patients with SE, including 81 (58%) with continuous SE and 59 (42%) with intermittent SE (repeated seizures without interictal recovery).

The 95 men and 45 women had a median age of 49 years (IQR 24–71). Median seizure time was 60 min (IQR 20–180), and 58 patients had seizures longer than 30 min. The SE was nonconvulsive in 16 (11%) patients and convulsive in 124 (89%), including 89 (64%) with tonic-clonic generalized seizures, 27 (19%) with partial seizures, 7 (5%) with myoclonic seizures, and 1 with tonic seizures. The most common causes of SE were cerebral insult in 53% and anticonvulsant drug withdrawal in 20% of patients. No cause was identified in 35% of patients. Median time from SE to treatment was 5 min (IQR 0–71). The SE was refractory in 35 (25%) patients. Mechanical ventilation was needed in 106 patients. Hospital mortality was 21%. By multivariate analysis, independent predictors of 30-day mortality were age (OR 1.03/year; 95% CI 1.00–1.06), GCS at scene (OR 0.84/point; 95% CI 0.72–0.98), continuous SE (OR 3.17; 95% CI 1.15–8.77), symptomatic SE (OR 4.08; 95% CI 1.49–11.10), and refractory SE (OR 2.83; 95% CI 1.06–7.54).

Mortality in SE patients remains high and chiefly determined by seizure severity. Further studies are needed to evaluate the possible impact of early maximal anticonvulsant treatment on outcomes.