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Erschienen in:
16.08.2023 | Short Commentary
How much refractory is ‘refractory status epilepticus’? A retrospective study of treatment strategies and clinical outcomes
Erschienen in: Journal of Neurology | Ausgabe 12/2023
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Background and purpose
This study aimed to evaluate whether differences in clinical outcomes exist according to treatments received and seizure activity resolution in patients with refractory status epilepticus (RSE).
Methods
Consecutive episodes of non-hypoxic status epilepticus (SE) in patients ≥ 14 years old were included. Episodes of RSE were stratified in: (i) SE persistent despite treatment with first‐line therapy with benzodiazepines and one second‐line treatment with antiseizure medications (ASMs), but responsive to successive treatments with ASMs (RSE-rASMs); (ii) SE persistent despite treatment with first‐line therapy with benzodiazepines and successive treatment with one or more second-line ASMs, but responsive to anesthetic drugs [RSE-rGA (general anesthesia)]. Study endpoints were mortality during hospitalization and worsening of modified Rankin Scale (mRS) at discharge.
Results
Status epilepticus was responsive in 298 (54.1%), RSE-rASMs in 152 (27.6%), RSE-rGA in 46 (8.3%), and super-refractory (SRSE) in 55 (10.0%) out of 551 included cases. Death during hospitalization occurred in 98 (17.8%) and worsening of mRS at discharge in 287 (52.1%) cases. Multivariable analyses revealed increased odds of in-hospital mortality with RSE-rGA (odds ratio [OR] 3.05, 95% confidence interval [CI] 1.27–7.35) and SRSE (OR 3.83, 95%. CI 1.73–8.47), and increased odds of worsening of mRS with RSE-rASMs (OR 2.06, 95% CI 1.28–3.31), RSE-rGA (OR 4.44, 95% CI 1.97–10.00), and SRSE (OR 13.81, 95% CI 5.34–35.67).
Conclusions
In RSE, varying degrees of refractoriness may be defined and suit better the continuum spectrum of disease severity and the heterogeneity of SE burden and prognosis.