Clinical Review

Management of Status Epilepticus in Adults


 

References

Treatment with barbiturates may contribute to these outcomes, although it is very challenging to prove causality in such a complex and prolonged ICU environment. Some data have shed light towards that direction: in a recent retrospective study of 171 patients with SE, of which 37% were treated with IV anesthetic drugs, there was a higher risk for infections and a 2.9-fold relative risk for death after adjustment for confounders in the group treated with IV anesthetics compared to the group without these agents [129].

The SE Severity Score (STESS, range 0–6) is a prognostic score for survival [130] and can be used as a scaffold for discussions with families and covariate adjustment tool for research. A favorable score of 0–2 has a negative predictive value of 0.97 for survival and likelihood to return to baseline clinical condition in survivors, although an unfavorable score (3–6) had a positive predictive value for death of only 0.39 [131].

The risk for recurrence of afebrile SE in a population-based study in Minnesota has been estimated at 31.7% over a 10-year follow-up period. The risk for recurrence was about 25% regardless of the underlying etiology, except in those patients with SE occurring in the setting of a progressive brain disorder (who had a 100% risk). Female gender, generalized (vs partial) SE and lack of response to the first AED after the initial episode of SE were independent factors for recurrence [132].

Conclusion

Despite the use of better diagnostic tools (continuous video EEG), advances in technology in the ICU, and availability of new AEDs, SE still carries significant mortality and morbidity, which depends mainly on age and etiology. The current treatment is still staged, with supportive measures and benzodiazepine administration remaining the mainstay initially and followed by older and newer AEDs and anesthetics for resistant cases. With the advance of pathophysiologic mechanisms elucidation at a molecular/receptor level, combinations of AEDs may become the foundation of future SE control.

Corresponding author: Panayiotis N. Varelas, MD, PhD, FNCS, Division Head, Neuro-Critical Care Service, Henry Ford Hospital, K-11, 2799 W. Grand Blvd., Detroit, MI 48202, pvarela1@hfhs.org.

Financial disclosures: Dr. Varelas was local principal investigator for a super-refractory status epilepticus study sponsored by Sage Therapeutics.

Author contributions: conception and design, ARR, PNV; analysis and interpretation of data, PNV; drafting of article, PNV; critical revision of the article, ARR, PNV; administrative or technical support, PNV; collection and assembly of data, ARR, PNV.

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