Abstracts

Rationale: Status epilepticus (SE) is a neurological emergency that requires immediate vigorous treatment in order to prevent serious morbidity or even death. Good data exist supporting the use of benzodiazepines and phenytoin as initial agents in treatment. However, super refractory status epilepticus(sr-SE) consists of seizures that are refractory to third line therapy, is extremely difficult to control and is associated with a poor outcome. In this study, we sought to look at our institutional experience with treatment of sr-SE with pharmacologic burst suppression.Methods: A retrospective chart review was conducted for all patients diagnosed with SE at our institutionbetween July 2013 and April 2014. For those with sr-SE, we collected baseline demographic information, side effects, and functional outcome at discharge and 1 year follow up.Results: Ninety-nine patients with SE were seen during the time period. Of these patients, 11 (11%) patients with sr-SE treated with pharmacologic suppression were identified. The mean age was 60 (range 41-87). Fourpatients (36%) had a history of epilepsy. The mean duration of status epilepticus was 7 days (range 1.5 -25 days, median 4.5 days). The mean duration of pharmacologic suppression (defined as >70% to fully suppressed) was 61 hours (range 24-96).The underlying etiology of SE was cardiac arrest and anoxic brain injury in four patients (36%),intracranial bleed in three patients (27%), and one patient each with cryptogenic encephalitis,metabolic related, alcohol withdrawal and metastatic lesions. The agent used was propofol in 18% (N=2), pentobarbital in 27% (N=3), or combination of midazolam and propofol in 54% (N=6). Two patients were suppressed a second time. The mean number of anti-epileptic medications tried prior to pharmacologic suppression was 4.3 (range 4-6). Complications occurred in all eleven patients, with 6 patients developing aspiration pneumonia(54%), and hypotension requiring pressor support in all patients (N =11, 100%). Outcomes were measured using the Glasgow outcome score (GOS). At follow up,63% (N=7, GOS 1) were dead andone patient had moderately severe disability (GOS of 4). Three patients (27%) who were in a persistent vegetative state at hospital discharge (GOS 2) were lost to long term follow up.Conclusions: Treatment of sr-SE with pharmacologic burst suppression can be associated with significant complications in most patients. The outcomes in this highly refractory group of patient remain poor, regardless of underlying etiology.