Abstracts

Rationale: To evaluate outcomes of patients with anoxic brain injury as the cause of status epilepticus (SE) in a level IV epilepsy center. Methods: Retrospective chart review of 360 patients with status epilepticus (SE) at Ochsner Neuro ICU during 2014-2016 was done with IRB approval. Diagnosis and resolution of SE was based on electroencephalography (EEG) reviewed by US board certified epileptologists. Results: Anoxic brain injury was the cause of SE in 54 patients. Demographics were 31 males and 23 females with age range of31-89 years. 52/54 (96%) had non-convulsive status epilepticus (NCSE) and 2/54 (4 %) patients convulsive status epilepticus (CSE). In-hospital stay was 2-40 days (mean 16.2, median 16). Overall outcome was 14 (25.9%) survivors and 40 (74.1%) deaths. (Tables 1a and 1b) NCSE resolved in 26/52 (50 %) and CSE resolved in all (100%). Mortality in resolved NCSE was 14/26 (52%) with 10/14 (71 %) from withdrawal of care (WOC) and 4/14 (29 %) due to medical complications. Mortality was 26/26 (100%) in unresolved NCSE, with 24/26 (92%) from WOC and 2/26 (8%) from medical complications (Table 2). IV AEDs used were Levetiracetam (51/54, 94.4 %), Lacosamide (45/54, 83.3 %) and Phenytoin (2/54, 3.7%). Other AEDs included Clobazam (11/54, 20.4 %), Valproate (11/54, 20.4 %), Vigabatrin (9/54; 16.7%) and Perampanel 5/54 (9.3%) Anesthetics were used in all (100 %) patients. Propofol and ketamine were used as single agents in 27/52 (52%, range 5-150 mkm) and 2/52 (3.8 %, range 5-200 mkm) respectively in NCSE. Both agents were used together in 23/52 (44.2%) in NCSE. Propofol was used as single agent in both (100%) patients with CSE with 100% resolution and no mortality. All 10 patients who had seizures controlled before WOC received AED combination of Lacosamide and Levetiracetam and Propofol. Conclusions: In our cohort, overall survival was 25.9% (14/54) with resolution of SE in 51.9%: NCSE in 50% (26/52) and CSE in 100% (2/2) Survival was associated with mean NICU stay of 22.7 (median 21) days in comparison to patients with WOC of mean 9.85 (median 9) days. Withdrawal of care was the most common cause of mortality unrelated to resolution of SE. Funding: None