Authors :
Jocelyn Cruz-Perez, MD – National Institute of Neurology and Neurosurgery
Jorge Alejandro Zepeda-Pérez, MD – National Institute of Neurology and Neurosurgery
Evelin Zulema Camacho-Castillo, MD – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Miguel Benjamín Cervera-Sánchez, MD – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Yazmin Palomares-Salazar, MD – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Clio Rubinos, MD, MS, FACNS – University of North Carolina, Chapel Hill, North Carolina, USA.
Iris E. Martínez-Juárez, MD, MS – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Daniel San-Juan, MD, MS – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Presenting Author: Daniel San-Juan, MD, MS – National Institute of Neurology and Neurosurgery. Mexico City, Mexico
Rationale:
There is a lack of real-world evidence on the diagnosis, treatment, and outcomes of refractory status epilepticus (RSE) in Latin America. This study aims to detail the clinical features, management, and outcomes of RSE in a tertiary neuro-critical care unit in Mexico.Methods:
We conducted a retrospective cohort study of adult patients (≥18 years) with RSE admitted between January 2010 and December 2022. Patients were identified via electronic medical records and included per International League Against Epilepsy (ILAE) defined RSE criteria. Clinical, radiological, laboratory, and electroencephalographic data were collected. Outcomes were assessed using seizure cessation rates and prognostic scores (mRS, STESS, END-IT). Statistical analysis included descriptive statistics and multinomial logistic regression to identify prognostic factors.Results:
We analyzed 102 RSE patients, 52.9% women, mean age 36.4 ±13.9 years, with a high prevalence of pre-existing epilepsy (70.6%). Most etiologies and triggers were preventable, including infections (23.5%) and medication non-adherence (10.8%). EEG showed generalized slowing in 29.4% and frontal interictal epileptiform discharges in 20.6%. Treatment response was heterogeneous; 83.2% required third-line therapies. Hospitalizations were prolonged (mean 32.1 days) with extended mechanical ventilation (mean 12.9 days). Functional outcomes showed moderate disability (median mRS=2). Prognostic scores (STESS and END-IT median=3) identified high-risk subgroups. Surgical interventions were infrequent (3.9%) but associated with high complication (71.5%) and sequelae rates (70.7%). Clinical resolution occurred in 87.3% of cases. Pre-existing epilepsy was significantly associated with prior SE episodes (p=0.011), unfavorable mRankin outcomes (p=0.046), and clinical resolution (p=0.001).
Conclusions:
This study provides real-world data on RSE in a resource-limited Latin American setting, emphasizing mostly preventable causes, complex management, and high acute care demands. Despite these challenges, favorable outcomes are achievable. Early diagnosis, aggressive treatment, and preventive strategies are critical to improve prognosis.
Funding: None