New-onset refractory status epilepticus: Etiology, clinical features, and outcome.

Academic Article

Abstract

  • OBJECTIVES: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus. METHODS: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale). RESULTS: Of 130 cases, 67 (52%) remained cryptogenic. The most common identified etiologies were autoimmune (19%) and paraneoplastic (18%) encephalitis. Full data were available in 125 cases (62 cryptogenic). Poor outcome occurred in 77 of 125 cases (62%), and 28 (22%) died. Predictors of poor outcome included duration of status epilepticus, use of anesthetics, and medical complications. Among the 63 patients with available follow-up data (median 9 months), functional status improved in 36 (57%); 79% had good or fair outcome at last follow-up, but epilepsy developed in 37% with most survivors (92%) remaining on antiseizure medications. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory CSF changes. CONCLUSIONS: Autoimmune encephalitis is the most commonly identified cause of new-onset refractory status epilepticus, but half remain cryptogenic. Outcome at discharge is poor but improves during follow-up. Epilepsy develops in most cases. The role of anesthetics and immune therapies warrants further investigation.
  • Published In

  • Neurology  Journal
  • Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Anesthetics, Anti-N-Methyl-D-Aspartate Receptor Encephalitis, Anticonvulsants, Autoantibodies, Cohort Studies, Encephalitis, Encephalitis, Herpes Simplex, Female, Hashimoto Disease, Humans, Length of Stay, Male, Middle Aged, Paraneoplastic Syndromes, Nervous System, Potassium Channels, Voltage-Gated, Prognosis, Retrospective Studies, Status Epilepticus, Time Factors, Treatment Outcome, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Gaspard N; Foreman BP; Alvarez V; Cabrera Kang C; Probasco JC; Jongeling AC; Meyers E; Espinera A; Haas KF; Schmitt SE
  • Start Page

  • 1604
  • End Page

  • 1613
  • Volume

  • 85
  • Issue

  • 18