Abstracts

Rationale: Status Epilepticus (SE) is a commonly encountered medical emergency, and a significant percentage of patients prove refractory to first- and second-line anticonvulsant therapies. Prolonged Refractory SE (PRSE) is status epilepticus that persists despite ≥7 days of continuous anesthetic infusion, and represents a rarer subset of SE, but is not infrequent in Neuro Intensive Care Units. We examined the pathology in a subset of our PRSE patients through biopsy and autopsy specimens. Methods: Three academic centers systematically identified patients with PRSE (excluding cardiac arrest) by review of records from 2001 to 2010. A subset of the study population who underwent biopsy and autopsy were included in the study and samples were examined by a certified Neuropathologist at each of the centers. Results: Sixty-three patients, 26 male and 37 females (age 14 to 86 yr), were identified with PRSE (SE duration 8 to 169 days). We reviewed the histo-pathological findings in 7 biopsies performed to establish a cause for PRSE. 3 out of the 7 samples established a diagnosis including radiation necrosis, gliotic brain with infract at site of brain metastatic lesion resection and atypical meningioma. Autopsies were performed on 6 out of 21 patients who died secondary to PRSE. 3 out of 6 samples provided an explanatory cause for their PRSE including sub acute bilateral occipital ischemia with acute to subacute global ischemia, acute ischemia and vasculitic changes secondary to Behcet's Disease (diagnosis made on multiple organ pathology evaluation) Conclusions: PRSE remains a clinically challenging entity. Biospy during PRSE was helpful, but in less than 50% of cases. More extensive neuro-pathological studies with autopsy specimens could help with establishing various etiologies of PRSE and guide in alternative and optimal treatment modalities. A larger study sample with multi-center cooperation would help in understanding the pathology of this severe form of SE.