Abstracts

Rationale: Status epilepticus (SE) is a medical and neurologic emergency. Optimal treatment approaches are not clearly defined and outcomes are often poor. To better understand SE causes, treatment approaches, and associated outcomes, we retrospectively reviewed all cases of SE treated at the Veterans Affairs Greater Los Angeles Healthcare System (VA WLA) over a period of 8 years. Methods: SE cases were identified via an electronic electroencephalogram (EEG) consult service tracking list from July 1, 2001 to June 30, 2009. Four-thousand five-hundred and nine EEG reports were reviewed and 72 cases of SE were identified. Causes of SE, efficacy of treatments used, and outcomes were assessed. Results: The most common causes of SE included anoxic/hypoxic injury (21%), cryptogenic/idiopathic etiologies (15%), traumatic brain injury (13%), and anti-epileptic drug (AED) non-adherence (11%). Lorazepam was the most frequently used first-line AED and was successful in terminating 24 of 54 SE cases (44%) when used first-line. Lorazepam followed immediately by phenytoin was used in only 5 cases as initial treatment and was successful in only 2 cases (40%). The mortality rate for SE overall was 31%. Twenty-two of 72 cases (31%) were refractory to two or more AEDs and considered to be refractory SE (RSE). The most common causes of SE in refractory cases did not significantly differ from that of medication-responsive patients and included anoxic/hypoxic injury (27% versus 18%), cryptogenic/idiopathic etiologies (13% versus 16%), traumatic brain injury (18% versus 10%), and AED non-adherence (9% versus 12%). Lorazepam, phenytoin, and propofol were the most frequently used antiepileptic drugs in RSE. Lorazepam was successful in terminating RSE in 9 of 19 cases (46%), phenytoin was successful in terminating RSE in 2 of 17 cases (12%), and propofol was successful in terminating RSE in 4 of 11 cases (36%). Other commonly used agents in RSE were midazolam, levetiractam, and phenobarbital which were effective in terminating RSE in 25%, 22% and 67% of cases respectively. As expected, RSE was associated with higher mortality than non-RSE cases (55% vs. 20%). Conclusions: Causes of SE in the veteran population are highly variable. Lorazepam continues to be one of the most effective AEDs in both medication-responsive SE and RSE. Phenobarbital, propofol, and midazolam may be the most effective agents in RSE after failure of lorazepam. Overall mortality rate in our SE cohort was similar to what is reported in the literature. However mortality rate for our RSE cohort were worse than what is reported in the literature, likely due to increased age and greater number of comorbidities associated with our veteran patients.