Skip to main content

Advertisement

SpringerLink
Log in

Association of seizure duration and outcome in refractory status epilepticus

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

The aim of the study was to identify factors influencing long-term outcome and to evaluate the prognostic power of the Status Epilepticus Severity Score (STESS) in refractory status epilepticus (RSE). We retrospectively extracted data on baseline characteristics, RSE details, and hospital course including complications from all patients treated for RSE in our institution between January 2001 and January 2013. Functional outcome was assessed using the modified Rankin Scale (mRS) and was defined as good when either RSE did not lead to functional decline or when the resulting mRS score was 2 or below. Seventy-one episodes in 65 patients were analyzed. The median follow-up time was 12 weeks (IQR 6–35), two patients were lost to follow-up. Poor functional long-term outcome was observed in 42/69 (60.9 %) episodes. In-hospital mortality occurred in 13/71 (18.3 %) episodes. Multivariable analysis revealed that STESS ≥ 3, longer RSE duration, and sepsis were independently related to poor functional long-term outcome. Receiver operating characteristics (ROC) curve analyses confirmed the cut-off dichotomization into STESS ≥ 3 and STESS < 3 for optimal discrimination between good and poor outcome (AUC = 0.671, p = 0.002, YI = 0.368, NPV = 0.607, PPV = 0.756) and revealed an RSE duration of 10 days as a significant cut-off point associated with outcome (AUC = 0.712, p = 0.012, YI = 0.310; NPV = 0.545, PPV = 0.750). In conclusion, STESS and RSE duration represent relevant scores and parameters impacting long-term outcome after RSE. A shorter RSE duration is associated with better outcome and, therefore, rapid and adequate treatment for seizure termination should be enforced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hocker S, Wijdicks EF, Rabinstein AA (2013) Refractory status epilepticus: new insights in presentation, treatment, and outcome. Neurol Res 35(2):163–168. doi:10.1179/1743132812Y.0000000128

    Article  PubMed  Google Scholar 

  2. Lowenstein DH (2006) The management of refractory status epilepticus: an update. Epilepsia 47(Suppl 1):35–40. doi:10.1111/j.1528-1167.2006.00658.x

    Article  PubMed  Google Scholar 

  3. Holtkamp M, Othman J, Buchheim K, Meierkord H (2005) Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 76(4):534–539. doi:10.1136/jnnp.2004.041947

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Rossetti AO, Logroscino G, Bromfield EB (2005) Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol 62(11):1698–1702. doi:10.1001/archneur.62.11.1698

    Article  PubMed  Google Scholar 

  5. Hocker SE, Britton JW, Mandrekar JN, Wijdicks EF, Rabinstein AA (2013) Predictors of outcome in refractory status epilepticus. JAMA Neurol 70(1):72–77. doi:10.1001/jamaneurol.2013.578

    Article  PubMed  Google Scholar 

  6. Cooper AD, Britton JW, Rabinstein AA (2009) Functional and cognitive outcome in prolonged refractory status epilepticus. Arch Neurol 66(12):1505–1509. doi:10.1001/archneurol.2009.273

    PubMed  Google Scholar 

  7. Standley K, Abdulmassih R, Benbadis S (2012) Good outcome is possible after months of refractory convulsive status epilepticus: lesson learned. Epilepsia 53(1):e17–e20. doi:10.1111/j.1528-1167.2011.03327.x

    Article  PubMed  Google Scholar 

  8. Peets AD, Berthiaume LR, Bagshaw SM, Federico P, Doig CJ, Zygun DA (2005) Prolonged refractory status epilepticus following acute traumatic brain injury: a case report of excellent neurological recovery. Crit Care 9(6):R725–R728. doi:10.1186/cc3884

    Article  PubMed  PubMed Central  Google Scholar 

  9. Thakur KT, Probasco JC, Hocker SE, Roehl K, Henry B, Kossoff EH, Kaplan PW, Geocadin RG, Hartman AL, Venkatesan A, Cervenka MC (2014) Ketogenic diet for adults in super-refractory status epilepticus. Neurology 82(8):665–670. doi:10.1212/WNL.0000000000000151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rossetti AO, Milligan TA, Vulliemoz S, Michaelides C, Bertschi M, Lee JW (2011) A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care 14(1):4–10. doi:10.1007/s12028-010-9445-z

    Article  CAS  PubMed  Google Scholar 

  11. Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB (2008) Status Epilepticus Severity Score (STESS): a tool to orient early treatment strategy. J Neurol 255(10):1561–1566. doi:10.1007/s00415-008-0989-1

    Article  PubMed  Google Scholar 

  12. Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, Laroche SM, Riviello JJ Jr, Shutter L, Sperling MR, Treiman DM, Vespa PM (2012) Guidelines for the evaluation and management of status epilepticus. Neurocrit Care 17(1):3–23. doi:10.1007/s12028-012-9695-z

    Article  PubMed  Google Scholar 

  13. Sutter R, Marsch S, Fuhr P, Ruegg S (2013) Mortality and recovery from refractory status epilepticus in the intensive care unit: a 7-year observational study. Epilepsia 54(3):502–511. doi:10.1111/epi.12064

    Article  PubMed  Google Scholar 

  14. Lowenstein DH, Bleck T, Macdonald RL (1999) It’s time to revise the definition of status epilepticus. Epilepsia 40(1):120–122

    Article  CAS  PubMed  Google Scholar 

  15. Holtkamp M (2011) Treatment strategies for refractory status epilepticus. Current opinion in critical care 17(2):94–100. doi:10.1097/MCC.0b013e328342fab5

    Article  PubMed  Google Scholar 

  16. Pugin D, Foreman B, De Marchis GM, Fernandez A, Schmidt JM, Czeisler BM, Mayer SA, Agarwal S, Lesch C, Lantigua H, Claassen J (2014) Is pentobarbital safe and efficacious in the treatment of super-refractory status epilepticus: a cohort study. Crit Care 18(3):R103. doi:10.1186/cc13883

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sutter R, Marsch S, Fuhr P, Kaplan PW, Ruegg S (2014) Anesthetic drugs in status epilepticus: risk or rescue? A 6-year cohort study. Neurology 82(8):656–664. doi:10.1212/WNL.0000000000000009

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Guidelines for epidemiologic studies on epilepsy (1993) Commission on Epidemiology and Prognosis, International League Against Epilepsy Epilepsia 34(4):592–596

  19. Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB (2006) Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry 77(5):611–615. doi:10.1136/jnnp.2005.080887

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Drislane FW, Blum AS, Lopez MR, Gautam S, Schomer DL (2009) Duration of refractory status epilepticus and outcome: loss of prognostic utility after several hours. Epilepsia 50(6):1566–1571. doi:10.1111/j.1528-1167.2008.01993.x

    Article  PubMed  Google Scholar 

  21. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60 II. Prognosis. Scottish Med J 2(5):200–215

    CAS  Google Scholar 

  22. Kowalski RG, Ziai WC, Rees RN, Werner JK Jr, Kim G, Goodwin H, Geocadin RG (2012) Third-line antiepileptic therapy and outcome in status epilepticus: the impact of vasopressor use and prolonged mechanical ventilation. Crit Care Med 40(9):2677–2684. doi:10.1097/CCM.0b013e3182591ff1

    Article  CAS  PubMed  Google Scholar 

  23. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF (2002) Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 59(2):205–210

    Article  PubMed  Google Scholar 

  24. Rossetti AO, Reichhart MD, Schaller MD, Despland PA, Bogousslavsky J (2004) Propofol treatment of refractory status epilepticus: a study of 31 episodes. Epilepsia 45(7):757–763. doi:10.1111/j.0013-9580.2004.01904.x

    Article  CAS  PubMed  Google Scholar 

  25. Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, Meyers E, Espinera A, Haas KF, Schmitt SE, Gerard EE, Gofton T, Kaplan PW, Lee JW, Legros B, Szaflarski JP, Westover BM, LaRoche SM, Hirsch LJ (2015) New-onset refractory status epilepticus: Etiology, clinical features, and outcome. Neurology. doi:10.1212/WNL.0000000000001940

    PubMed  Google Scholar 

  26. Sutter R, Kaplan PW, Ruegg S (2013) Independent external validation of the status epilepticus severity score. Crit Care Med 41(12):e475–e479. doi:10.1097/CCM.0b013e31829eca06

    Article  PubMed  Google Scholar 

  27. Rossetti AO, Logroscino G, Bromfield EB (2006) A clinical score for prognosis of status epilepticus in adults. Neurology 66(11):1736–1738. doi:10.1212/01.wnl.0000223352.71621.97

    Article  PubMed  Google Scholar 

  28. Sutter R, Grize L, Fuhr P, Ruegg S, Marsch S (2013) Acute-phase proteins and mortality in status epilepticus: a 5-year observational cohort study. Crit Care Med 41(6):1526–1533. doi:10.1097/CCM.0b013e318287f2ac

    Article  PubMed  Google Scholar 

  29. Vezzani A, Friedman A, Dingledine RJ (2013) The role of inflammation in epileptogenesis. Neuropharmacology 69:16–24. doi:10.1016/j.neuropharm.2012.04.004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Marchi NA, Novy J, Faouzi M, Stahli C, Burnand B, Rossetti AO (2015) Status epilepticus: impact of therapeutic coma on outcome. Crit Care Med. doi:10.1097/CCM.0000000000000881

    PubMed  Google Scholar 

  31. Claassen J, Hirsch LJ, Emerson RG, Mayer SA (2002) Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 43(2):146–153

    Article  CAS  PubMed  Google Scholar 

  32. Lai A, Outin HD, Jabot J, Megarbane B, Gaudry S, Coudroy R, Louis G, Schneider F, Barbarot N, Roch A, Lerolle N, Luis D, Fourrier F, Renault A, Argaud L, Sharshar T, Gibot S, Bollaert PE (2015) Functional outcome of prolonged refractory status epilepticus. Crit Care 19:199. doi:10.1186/s13054-015-0914-9

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sutter R, Kaplan PW, Marsch S, Hammel EM, Ruegg S, Ziai WC (2015) Early predictors of refractory status epilepticus: an international two-center study. Euro J Neurol Off J Euro Feder Neurol Soci 22(1):79–85. doi:10.1111/ene.12531

    CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by a research grant (ELAN-13-07-15-1) from the ELAN Fonds University of Erlangen-Nuremberg, Germany. We would like to thank Inken Martin, MD, PhD (Victor Chang Cardiac Research Institute, Sydney, Australia) for critically proofreading the manuscript as well as Olaf Bergmann, MD, PhD (Karolinska Institute, Stockholm, Sweden) for valuable discussions.

Author information

Authors and Affiliations

  1. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Dominik Madžar, Anna Geyer, Ruben U. Knappe, Stephanie Gollwitzer, Joji B. Kuramatsu, Stefan T. Gerner, Hajo M. Hamer & Hagen B. Huttner

Authors
  1. Dominik Madžar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anna Geyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruben U. Knappe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie Gollwitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joji B. Kuramatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefan T. Gerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hajo M. Hamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hagen B. Huttner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominik Madžar.

Ethics declarations

Conflicts of interest

The authors report no conflicts of interest relevant to this study.

Ethical standard

The study was approved by the local institutional review board (Ethics Committee Vote: 48_15Bc).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Madžar, D., Geyer, A., Knappe, R.U. et al. Association of seizure duration and outcome in refractory status epilepticus. J Neurol 263, 485–491 (2016). https://doi.org/10.1007/s00415-015-7992-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-015-7992-0

Keywords

Search

Navigation