Abstracts

RATIONALE: Status epilepticus (SE) that does not respond to standard treatment (refractory SE) is associated with a significant morbidity and mortality and represents a major clinical challenge. However, little is known about the causes and characteristics of refractory SE. Thus, the present study was initiated to evaluate the clinical presentations, mortality, risk factors, and predictors of refractory SE in a large series of SE cases in a prospective population based data base.
METHODS: The prospective population based data base for SE developed at Virginia Commonwealth University was utilized to identify cases of refractory SE. The clinical characteristics of each case were evaluated and correlated with multiple factors including seizure duration, morbidity, mortality, response to treatment, and other variables. The data were analyzed by multivariate and univariate statistical analysis.
RESULTS: Patients that did not respond to initial treatment were evaluated and the time to first treatment was determined for each SE case. Duration of SE was found to contribute to the development of refractory SE. However, a novel finding was that a significant proportion of SE cases were refractory to treatment despite a short seizure duration prior to treatment. Etiology was also found to contribute to the response to treatment. The effects of age, race, etiology, seizure duration, sex, and other variables were evaluated employing multivariate statistical analysis to determine their contribution to the development of refractory SE. Response to initial treatment was evaluated as a rapid test for the identification of refractory SE. Lack of respose to the initial treatment was highly predictive of increased mortality and the development of refractory SE.
CONCLUSIONS: Refractory SE was associated with a significant morbidity and mortality. Although seizure duration contributed to the development of refractory SE, other factors such as etiology also played an important role in the development of this condition. Refractory SE that was associated with an increased morbidity and mortality could be readily identified by a simple clinical treatment response. This clinical test may prove useful in identifying this important form of SE. The results indicate that understanding the clinical manifestations and pathophysiology of refractory SE may provide new insights into the treatment and prevention of this condition.
Support: This work was supported by NINDS grants P50NS25630 and RO1 NS23350 to RJD.