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Long-term outcome of refractory status epilepticus in adults: A retrospective population-based study

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Date
2017
Author
Kantanen A-M
Reinikainen M
Parviainen I
Kälviäinen R
Unique identifier
10.1016/j.eplepsyres.2017.03.009
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Citation
Kantanen A-M. Reinikainen M. Parviainen I. Kälviäinen R. (2017). Long-term outcome of refractory status epilepticus in adults: A retrospective population-based study.  EPILEPSY RESEARCH, 133, 13-21. 10.1016/j.eplepsyres.2017.03.009.
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CC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/
Abstract

Purpose
Refractory status epilepticus (RSE) is a neurological emergency with significant morbidity and mortality. We aimed to analyze the long-term outcome of intensive care unit (ICU)-treated RSE and super-refractory status epilepticus (SRSE) patients in a population based cohort.

Methods
A retrospective study of ICU- and anesthesia-treated RSE patients in Kuopio University Hospital’s (KUH) special responsibility area hospitals in the central and eastern part of Finland from Jan. 1, 2010 to Dec. 31, 2012 was conducted. KUH’s catchment area consists of five hospitals—one university hospital and four central hospitals—and covers a population of 840 000. We included all consecutive adult (16 years or older) RSE patients admitted in the participating ICUs during the 3-year period and excluded patients with postanoxic etiologies. We used a modified Rankin Scale (mRS) as a long-term (1-year) outcome measure: good (mRS 0–3, recovered to baseline function) or poor (mRS 4–6, major functional deficit or death).

Key findings
We identified 75 patients with ICU- and anesthesia-treated RSE, corresponding to an annual incidence of 3.0 (95% confidence interval (CI) 2.4–3.8). 21% of the patients were classified as SRSE, with the annual incidence being 0.6/100 000 (95% CI 0.4–1.0). For RSE, the ICU mortality was 0%, hospital mortality was 7% (95% CI 1.2%–12.8%) (n = 5), and one-year mortality was 23% (CI 95% 13.4%–32.5%) (n = 17). 48% (n = 36) of RSE patients recovered to baseline, and 29% (n = 22) showed neurological deficit at 1 year. Poor outcome (mRS 4–6) was recorded for 52% (n = 39) of the patients. Older age was associated with poorer outcome at 1 year (p = 0.03). For SRSE, hospital mortality was 6% (n = 1) and 1-year mortality was 19% (n = 3) (95%CI 0%–38.2%).

Significance
During 1-year follow-up, nearly 50% of the ICU-treated RSE patients recovered to baseline function, whereas 30% showed new functional defects and 20% died. SRSE does not have a necessarily poorer outcome. The outcome is worse in older patients and in patients with progressive or fatal etiologies. SE should be treated with generalized anesthesia only in refractory cases after failure of adequately used first- and second-line antiepileptic drugs.

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https://erepo.uef.fi/handle/123456789/4927
Link to the original item
http://dx.doi.org/10.1016/j.eplepsyres.2017.03.009
Publisher
Elsevier BV
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