Abstracts

Status epilepticus (SE) is an acute neurological disorder that requires prompt and effective therapy. The short-term mortality of SE in a population-based cohort is approximately 20% (Epilepsia 1997;38:1344-1349). Long-term digital video-EEG monitoring (DVEEG) is useful for the diagnosis of refractory SE and in monitoring the response to therapeutic interventions. The rationale for the present study is to analyze the electroclinical correlation and outcome of patients admitted to the Neuro ICU with SE refractory to intravenous benzodiazepine drugs or phenytoin, or both
We performed a retrospective study evaluating the clinical factors and outcome of SE in a consecutive series of patients admitted to the Neuro ICU at Mayo Clinic, Rochester MN between January 1994 and July 2001. The medical histories and hospital charts were reviewed. All patients underwent a 30 minute EEG recording and DVEEG. The patients were separated into three groups based on their electroclinical presentation: generalized convulsive SE (GCSE), nonconvulsive SE (NCSE), and epilepsia partialis continua (EPC).
71 patients were derived from 612 consecutive patients admitted to the Neuro ICU for DVEEG. There were 34 men (48%) and 37 women (52%). GCSE occurred in 45 patients (63%), NCSE in 19 patients (27%), and EPC in 7 patients (10%). Patients with NCSE experienced an encephalopathy following repetitive seizures (53%), confusion with behavioral problems (37%), and staring spells with automatisms (16%). Periodic lateralizing epileptiform discharges (PLEDs) (p[lt]0.04), generalized background slowing (p[lt]0.02), and a burst suppression pattern (p[lt]0.003) were observed in patients with GCSE. In patients with NCSE generalized background slowing (p[lt]0.004) was present. Generalized epileptiform discharges (p[lt]0.003) and PLEDs (p[lt]0.001) were prominent EEG abnormalities in patients with EPC. The mean follow-up was 7 months (range, 1-52 months). The mortality was 19 of 45 patients (42%) with GCSE, 6 of 19 patients (32%) with NCSE, and 3 of 7 patients (43%) with EPC. Six of the 19 patients (13%) with GCSE had a severe neurological deficit. Only 5 patients (11%) with GCSE and 1 patient (14%) with EPC had a normal neurological examination during follow-up. None of the patients with NCSE had an excellent outcome. With multivariate logistic regression analysis the presence of multiple strokes (p[lt]0.03, odds ratio 5.62) was predictive of mortality
Refractory SE requiring admission to the Neuro ICU and computer-assisted video-EEG monitoring has a significant potential for serious morbidity and mortality. A minority of the patients in the present series had an excellent neurological outcome.