Long-term outcomes in refractory status epilepticus

ABSTRACT

Introduction

Refractory status epilepticus (RSE) is a diagnosis that can be made when tonic-clonic status epilepticus (SE) and focal SE cannot be stopped by at least two anti-seizure medications after 30 and 60 minutes, respectively, from the time of commencement. It could result in mortality, loss of functionality, neurological deficiency, and other serious short- and long-term effects.

Areas covered

This narrative review covers original clinical studies of any design and case series investigating long-term outcomes of RSE recorded after at least a year from the SE onset.

Expert opinion

The future of a patient with RSE rests mostly on the long-term effects of this severe pathological condition, which may be accompanied with systemic complications like hyperthermia, hyperkalemia, acidosis, and/or stress cardiomyopathy. Younger patients with less severe RSE of shorter duration, particularly of the convulsive kind, are reported to have better long-term outcomes. Previous studies on the factors influencing the long-term outcomes of RSE, however, did not link the outcomes to treatment options for the condition. Such circumstances currently prevent making any definitive recommendations on the treatment of RSE until future research with adequate statistical power is completed.

KEYWORDS:

• Refractory status epilepticus
• antiseizure drugs
• treatment response
• long term outcomes
• super-refractory status epilepticus
• intravenous anesthetics

Article highlights

• Refractory status epilepticus (RSE) is a condition where tonic-clonic status epilepticus (SE) and focal SE cannot be stopped by at least two anti-seizure medications after 30 and 60 minute periods respectively

• Long-term outcomes of RSE or SRSE after a year or more reported by available clinical studies are limited to: general functional status of a patient, mortality rate, new neurological deficit, need for antiseizure medication, administration of rescue antiseizure medication, rate of repeated RSE and post SE epilepsy.

• The factors associated with long-term outcomes that are repeatedly reported are age of the patients, duration of stay in the intensive care unit (ICU), duration of SE and its treatment, use of continuous infusion of anesthetics and severity of the SE and its complications.

• Neither the treatment type, nor the etiology of SE could be related to the long-term outcomes of RSE thus far.

• Further research is absolutely necessary to discover what treatments of RSE more rapidly abort the status, decrease acute damage of brain and other tissues, and therefore are associated with improvement of the long-term outcomes.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors are funded by the Ministry of Education, Science and Technological Development, Serbia via grant no. 175007/contract No 451-03-47/2023-01/200111.