Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit

Objective: To assess risk factors and prognosis in patients with refractory status epilepticus (RSE). Methods: We retrospectively analysed all episodes of status epilepticus (SE) treated between 1993 and 2002 on the neurological intensive care unit (NICU) of the Charite-Universitatsmedizin Berlin. The predictive and prognostic features of RSE were compared with non-RSE (NRSE). All patients with "de nova" SE were followed up to identify the possible development of post-SE symptomatic epilepsy. Results: A total of 83 episodes fulfilled our criteria of SE. Of these 43% were refractory to first line anticonvulsants. The mean age of patients with SE was 53.3 (SD 19) years, with only two patients younger than 18 years. Encephalitis was significantly more often the primary cause in RSE (p < 0.05), whereas low levels of antiepileptic drugs were significantly more often associated with NRSE (p < 0.001). Hyponatraemia within the first 24 hours after onset of status activity was significantly more often associated with RSE (p < 0.05). In RSE, compared with NRSE, significantly longer duration of seizure activity (p < 0.001), more frequent recurrence of epileptic activity within the first 24 hours after the end of seizure activity (p < 0.001), longer stay in the NICU and in hospital (p < 0.001 and p < 0.01, respectively), and more frequent development of symptomatic epilepsy (p < 0.05) were seen. Conclusions: SE treated in the NICU is frequently refractory to first line anticonvulsant drugs. Encephalitis is a predictor for RSE, which is associated with markedly poor outcome, in particular, the development of post-SE symptomatic epilepsy. Thus prevention of this most severe form of SE should be the primary target of treatment of SE.