Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Abstract

Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery. Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated. Results: Of 467 patients, the median age was 66.7 years and mortality was 12%.Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99). Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed.

New-onset super refractory status epilepticus: A case-series

“…It is apparent that patients admitted with a diagnosis of NORSE have very prolonged hospital stays. The longest duration of SE in a recently published adult SE cohort from 2005 to 2016 was 43 days [24] and length of stay was 21 days in the other landmark cohort of 130 cases [6]. By contrast two of our patients spent 210 and 115 days each in SE, with the former case being one of the longest cases of SE yet recorded in literature.…”

Increased occurrence of status epilepticus in patients with brain metastases and checkpoint inhibition

“…Patients were treated with different strategies that might influence the outcome of SE as shown in several studies. [14][15][16] Individual cases may therefore respond differently to treatments and have contrasting prognoses.…”

Super refractory status in a case of Febrile Infection‐Related Epilepsy Syndrome due to hemophagocytic lymphocytic histiocytosis

“…When seizures recur beyond a week, status epilepticus is said to be “prolonged,” and hence, we added further immunomodulation. 7 These were in the form of the anti‐CD 20 monoclonal antibody, rituximab, and the chemotherapeutic agent cyclophosphamide that has been anecdotally used in the past in the treatment of FIRES. We also used anakinra, a recombinant modified version of human interleukin‐1 receptor antagonist protein which could be useful in severe refractory autoimmune encephalitis 8 .…”