Abstracts

RATIONALE: While etiology underlying status epilepticus (SE) is a primary determinant of outcome, duration of SE appears to play a major role in determining neurological outcome. Survival following prolonged SE is unusual, and when it occurs is associated with severe neurological deficits. Review of the recent literature yielded 4 patients experiencing good neurological recovery following [gt]1.5 days of SE.
METHODS: An established definition of SE (seizures [gt]30 minutes or recurrent seizures without recovery to baseline within 30 minutes) was used to identify patients with protracted SE treated between 1993 and 1999. Presentation, etiology, treatment, hospital course and follow up evaluations were examined.
RESULTS: 4 patients ages 7, 12, 31 & 68 yrs had SE lasting 4 to 20 days. 1 had generalized tonic-clonic SE, 1 had complex partial SE and 2 subtly convulsive SE. The etiologies were cerebral contusion in 1 and encephalitis in 3, although, a pathogen for the encephalitis could not be defined. All patients were placed in a therapeutic coma with either pentobarbital (3) or barbiturates, benzodiazepine drip, and propofol. The duration of therapeutic coma was 4 to 20 days. Subsequent hospitalization was for 35 to 155 days. Follow-up was 1.5 to 7 yrs. 1 patient continued to experience seizures and 2 of the patients had epileptiform discharges on EEG. All patients were discharged to rehabilitation or nursing home settings. All patients achieved remarkable recoveries; they were able to speak, walk, and manage their daily living activities at a minimum. Residual functional deficits were: 1) 7 yo with mild memory and attentional difficulties at 2 yrs follow-up, 2) 12 yr old with moderate memory and cognitive disabilities at 1.5 yrs follow up, 3) 31 yo with slowed speech at 1.5 yrs follow-up, and 4) 68 yo who made a full recovery and was able to drive at 7 yrs.
CONCLUSIONS: All patients experienced a prolonged hospital and rehabilitation course following therapeutic coma for protracted SE. Recovery may be a result of 1) etiology being encephalitis or cerebral contusion, 2) SE was acute symptomatic in nature, 3) good health prior to SE, and 4) aggressive management of SE. This series appears to demonstrate that underlying etiology for SE exerts a more powerful influence on recovery than duration of SE per se. Duration of SE should probably play a secondary role in decisions where withdrawal of support during the treatment of intractable SE is being considered.