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Clinical Outcomes Following Prolonged Refractory Status Epilepticus (PRSE)

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Abstract

Background

To define the clinical profile and outcome of patients in prolonged refractory status epilepticus (PRSE), and investigate possible predictors of outcome.

Methods

We reviewed 63 consecutive patients with PRSE cared for in the medical and neurointensive care units of three academic medical centers over a 9-year period. For this multi-center retrospective cohort study, PRSE was defined as SE that persisted despite at least 1 week of induced coma. Variables examined for their relationship to outcome included etiology, EEG, neuroimaging, and age.

Results

Forty-two (66 %) of 63 patients in PRSE survived to discharge from hospitalization. Fourteen (22 %) patients had a good outcome (mRS ≤ 3) at last available follow up (at least 6 months post-PRSE). Of these, 6 (10 %) individuals had no significant disability and were able to carry out all usual activities (mRS = 1). Normal neuroimaging and a reactive EEG at onset of PRSE were associated with good outcome. Good or excellent clinical outcomes were possible in patients in PRSE for up to 79 days, and in patients up to 69 years old.

Conclusions

Good outcome is not unusual in PRSE, including in some older patients, in a variety of diagnoses, and despite months of coma.

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Acknowledgment

This study was conducted on behalf of the Critical Care EEG Monitoring Research Consortium. The Critical Care EEG Monitoring Research Consortium receives support from the American Epilepsy Society.

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Authors and Affiliations

  1. Division of Epilepsy, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA

    R. D. Kilbride

  2. Comprehensive Epilepsy Center, Neurological Institute, 710 W 168th St., New York, NY, 10032, USA

    A. S. Reynolds

  3. Department of Neurology, University of Alabama at Birmingham, 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294, USA

    J. P. Szaflarski

  4. Division of Epilepsy and EEG, Comprehensive Epilepsy Center, Critical Care EEG Program, Yale University School of Medicine, 15 York St, LLCI-714, New Haven, CT, 06510, USA

    L. J. Hirsch

Authors
  1. R. D. Kilbride
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  2. A. S. Reynolds
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  3. J. P. Szaflarski
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  4. L. J. Hirsch
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Corresponding author

Correspondence to R. D. Kilbride.

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Kilbride, R.D., Reynolds, A.S., Szaflarski, J.P. et al. Clinical Outcomes Following Prolonged Refractory Status Epilepticus (PRSE). Neurocrit Care 18, 374–385 (2013). https://doi.org/10.1007/s12028-013-9823-4

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  • DOI: https://doi.org/10.1007/s12028-013-9823-4

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