Refractory status epilepticus (RSE) is commonly defined as status epilepticus (SE) resistant to treatment with 1 first-line antiepileptic drug (benzodiazepines) and 1 second-line antiepileptic drug (phenytoin, phenobarbital, or valproate acid). Outcome was independent of the specific coma-inducing agents used and the extent of EEG burst suppression, suggesting that the underlying cause represents its main determinant. Demographic data, clinical variables, and outcome did not differ significantly with the various coma-inducing agents or between episodes with and without EEG burst suppression.Ĭonclusions Refractory status epilepticus is more prevalent in incident than in recurrent status epilepticus and is associated with higher mortality clinical status is less likely to return to baseline than with non-RSE. In 20 (61%) of 33 monitored episodes, EEG burst suppression was achieved. Return to baseline occurred more often in the non-RSE group ( P = .04). Mortality was 23% for patients with RSE and 8% for those without RSE ( P = .05). Results Forty-nine episodes of RSE (47 patients) were found, occurring more frequently in incident than in recurrent episodes of status epilepticus ( P = .06). Main Outcome Measures Short-term mortality and prevalence of return to functional baseline after the acute episode of status epilepticus were analyzed in relation to demographic and clinical variables and to treatment option (antiepileptic agents and EEG burst suppression). Patients Among 127 consecutive episodes (107 patients) of status epilepticus, we identified episodes that were refractory to first-line and second-line antiepileptic drugs, needing induced coma with barbiturates, propofol, or midazolam for clinical management. Setting Two tertiary referral hospitals in Boston, Mass.
Objective To investigate whether various coma-inducing options are associated with different prognoses after RSE.ĭesign Retrospectively assessed case series. Moreover, the effect on outcome of electroencephalographic (EEG) burst suppression remains unclear.