Abstracts

Rationale: Status epilepticus (SE) does not respond to first and second line antiepileptic therapy 31-43% of the time, and in some cases may persist for weeks or months. In this study, we report the treatment and functional outcome of patients with SE requiring continuous anesthetic suppression for greater than one week. Methods: We retrospectively reviewed records of patients undergoing continuous EEG monitoring from January 1999 through March 2008 at our institution to identify patients with prolonged refractory status epilepticus (PRSE). PRSE was defined as SE in which treatment with anesthetic agents was required for ≥ 7 days to suppress SE. Patients with epilepsia partialis continua, anoxic brain injury, and those who did not undergo continuous EEG monitoring were excluded. A chart review was performed to determine the Modified Rankin Scale (MRS) scores of each patient prior to his or her episode of PRSE and at hospital discharge. A structured telephone interview was developed to assess follow-up functional and cognitive outcome using the MRS and the Telephone Interview for Cognitive Status (TICS). The duration of SE, number of anti-epileptic drugs (AEDs) used, and length of ICU and hospital stay were measured. Results: Twelve patients were identified. Eight subjects (67%) were men, and the median age was 52 years (range 20-69). Median duration of SE was 17 days (range 7-67), and seven had a PRSE duration of > two weeks. Median length of ICU stay was 20 days (range 7-97), and median length of hospitalization was 26 days (range 7- 125). Etiologies of PRSE were related to stroke, tumor, familial progressive myoclonus syndrome, Lennox Gastaut syndrome, encephalitis, lupus, and thrombotic thrombocytopenic purpura. Etiology was undetermined in one case. Patients received an average of two anesthetic drugs during treatment of PRSE. Anesthetic agents included propofol, midazolam, and pentobarbital, either as a single drug or in combination. In addition to anesthetic drugs, a median of five maintenance AEDs (range 4-7) per patient was initiated singly and in combination in an effort to abort SE. Median follow up was 969 days (range 106-2902). Eight patients (67%) died and four (33%) survived. Of the eight deaths, six died during their course of PRSE, and two died 3 and 12 months after hospital dismissal. Of the four surviving patients, two showed functional improvement on the MRS. One patient could not be evaluated with the TICS due to severe pre-existing cognitive deficits. The other three patients scored a median of 30 (range 29-34) on the TICS (maximum score = 41, normal ≥ 31). Conclusions: Outcome is poor in most patients with PRSE. However, some patients with PRSE improve following hospital discharge and achieve meaningful functional and cognitive recovery. These results suggest that the presence of PRSE alone is insufficient reason to terminate treatment of status epilepticus.