Outcomes in 140 critically ill patients with status epilepticus

Abstract

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

Design and setting: An 8-year retrospective study.

Subjects and intervention: 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).

Measurements and results: 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).

Conclusion: 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.