Abstracts

Rationale: Refractory Status Epilepticus (RSE), defined as status epilepticus (SE) that fails to respond to first- and second- line therapy, occurs in 9-31% of patients with SE and is associated with high morbidity and high mortality. Partial or complete suppression of abnormal EEG patterns via continuous intravenous administration of general anesthetics is usually recommended for treatment of RSE. Despite its widespread use, there remains no clear consensus on the use of this treatment. The challenge herein is that patients with RSE constitute a significantly heterogeneous population with respect to their etiology and co-morbidities. In addition, their treatment is highly variable from center to center, and even within a single center. Therefore, as a first step towards improving the management of RSE, in this study, we reviewed cases of RSE with the primary aim of determining whether the degree of EEG suppression influenced outcome. Methods: Retrospective review of patients who were treated for RSE at St Joseph’s Hospital and Medical Center in 2008 was performed. These patients were identified by reviewing EEG reports, discharge summaries and in-patient databases. Statistical analysis was performed in order to study the effect of treatment on the outcome of these patients. Results: Retrospective review yielded a total of 29 with RSE, as determined by either a stat EEG or continuous EEG and medications administered. Of the 29 patients, 4 achieved complete suppression, 10 achieved burst suppression and 15 were not suppressed. Per the last EEG, 12 patients had cessation of status and 17 continued to have an ictal pattern on the last EEG done during the hospital stay. Outcome was divided into 3 categories: functional, non-functional and terminal. 8 patients were functional at discharge, 7 were non-functional and 14 had a terminal outcome. Linear regression analysis showed no statistically significant relationship between depth of EEG suppression and outcome (p>0.7) or cessation of RSE (p>0.1). The relationship between the cessation of RSE and outcome was also not significant (p>0.8). Conclusions: Among the 29 patients identified, depth of EEG suppression did not correlate with outcome. We examined one aspect of treatment, but there are many variables to consider. Although the patients were all at one institution, there was neither a standard AED treatment nor a standard goal for suppression on EEG. Etiology varied between vascular, malignant, infectious, metabolic, anoxic and cryptogenic causes. Co-morbidities also influenced the dose of AEDs that patients could receive to induce suppression. The lack of consensus on management reflects the complexity of RSE. Further research is needed to better guide management of RSE in order to optimize outcome.