Abstracts

Rationale: Status epilepticus (SE) is one of the neurological emergency that requires early recognition and treatment. Initial treatment of SE typically consists of benzodiazepines followed by standard intravenous antiepileptics. Failure of any one of these typical regimens for SE treatment should constitute refractory SE (RSE). With respect to the general approach to treatment of RSE, whether factor related with prediction of outcome is unclear. Methods: We retrospectively analyzed refractory status epilepticus (RSE) patients who admitted our hospital from April 2010 to April 2013. RSEs related to hypoxic brain damage, drug intoxication, or ingestion of insecticide, such as organophosphates were excluded. 43 consecutive patients with RSE were enrolled. The hospital arrival time and the intensive care admission time were investigated for counting exact waiting time at emergency room (ER). Peripheral cell count, C-reactive protein (CRP), liver function test, renal function test including electrolytes, lactate, ammonia, muscle enzymes, brain images, and electroencephalographic monitoring were performed in all patients. Modified Rankin score (mRS) at discharge and 3 months later were measured as the scale of functional outcome in RSE patients. The subjects were divided into two groups, good and poor outcome groups. More than 4 point of mRS at discharge with no improvement on 3 months later, deterioration of mRS score compare with at discharge and 3 months later, or more than 4 point of mRS on 3 months later were classified as poor outcome group. Results: 16 of 43 RSE patients (37%) were expired at discharge. 3 patients were dead on 3 months later. 23 of 43 RSE patients were classified as poor outcome group. High CRP (4.21±7.024 in poor group vs. 2.15±4.806 in good group, p=0.025), the prolonged waiting time at ER (34.22±54.688 hr in poor group vs. 5.03±7.779 hr in good group, p=0.001), low albumin (3.55±0.649 in poor group vs. 3.83±0.677 in good group, p=0.030), and low ammonia (81.83±53.284 in poor group vs. 104.25±66.415 in good group p=0.035) were significantly associated with poor outcome group. In regression analysis, only the prolonged waiting time was independently associated with the outcome of the RSE (OR: 1.08, 95% CI: 1.001-1.160). Conclusions: Outcome of patients with RSE is poor. Higher mortality and lower rate of return to baseline was seen in the RSE patients. Continuous monitoring, intravenous antiepileptic drug with many alternative or additional interventions have been suggested in treatment of the RSE. There is a strong consensus about the need for an early, effective treatment to prevent morbidity and mortality. These early multimodal approaches could perform easily in the intensive care unit. Therefore early intensive care is an important factor for improving outcome of the RSE.