Abstracts

Rationale: Status epilepticus (SE) is associated with poor outcome. Refractory SE (RSE), acute etiology, nonconvulsive SE (NCSE) and SE duration have been correlated with increased mortality. However, the literature is limited regarding modifiable parameters for SE and long-term functional outcome. The aims of this study were to: 1) determine whether latency to treatment of SE (LTSE) is associated with long-term survival and 2) describe long-term functional outcome among SE survivors. Methods: This was a retrospective study of patients with SE admitted to a university hospital between 2005-2012, with prospective telephone follow-up of survivors after hospitalization. Subjects were subdivided by LTSE into those treated within 10 (LTSE≤10), 30 (LTSE≤30), 60 (LTSE≤60) and 120 (LTSE≤120) minutes. Baseline characteristics included age, gender, acute etiology, cardiac arrest (CA), SE duration, NCSE and RSE. Classification of SE was based on the Neurocritical Care Society's 2012 Guidelines for the Evaluation and Management of Status Epilepticus. Outcome measures were survival and modified Rankin Scale score (mRS) at hospital discharge and in long-term follow-up. Continuous and categorical data was assessed using 2-tailed t-testing and Pearson's Chi2, respectively. Logistic regression analysis adjusted for covariates. Significance was set at p≤0.05. Results: The cohort consisted of 97 subjects with known final outcome, identified from 151 cases of SE. Long-term follow-up ranged from 2-7 years. Mean age=60 years, 47%(N=46) were male. In 64%(N=62), etiology was acute, 39%(N=38) underwent CA, 37%(N=36) had NCSE, 90%(87) had RSE, and 77%(N=75) of SE was >12 hours in duration. By hospital discharge, 61/97(63%) subjects were deceased. Of the remaining subjects, 25/36(69.4%) subsequently died, for an overall mortality of 88.7%(N=86). Over the entire cohort, CA (p=0.005) and acute etiology (p<0.01) were more frequent in deceased subjects, but not among the 36 with long-term follow-up; otherwise there were no significant differences in age, gender, NCSE, RSE and SE duration. In immediate and long-term follow-up, LTSE≤30 (p=0.013, p=0.043) and LTSE≤60 (p=0.019, p=0.035) was significantly associated with survival; LTSE≤10 was significant over the entire cohort only (p=0.03). In univariate and multivariate analysis of the entire cohort, survival remained significantly associated with LTSE≤10. For LTSE≤30, this was attenuated by acute etiology, and for LTSE≤60, by older age, male gender and acute etiology. In the 36 subjects with long-term follow-up, survival remained significantly associated with LTSE≤30 and LTSE≤60 after univariate and multivariate adjustment (p<0.05). At hospital discharge, mRS was significantly better in survivors, and mean follow-up mRS=1.14. Two of 11 survivors reported seizures since hospital discharge, 8 were prescribed antiepileptic drugs, and 6 were on monotherapy. Conclusions: Survival and better functional outcome after status epilepticus is significantly associated with initial treatment within 60 minutes, and is not modified by acute seizure etiology, older age and male gender if treated within 10 minutes.