title: Outcomes in 140 critically ill patients with status epilepticus.
abstract: OBJECTIVE
  Despite recent management guidelines, no recent study has evaluated outcomes in ICU patients with status epilepticus (SE).
  
  
  METHODS
  An 8-year retrospective study.
  
  
  METHODS
  Observational study in 140 ICU patients with SE, including 81 (58%) with continuous SE and 59 (42%) with intermittent SE (repeated seizures without interictal recovery).
  
  
  RESULTS
  The 95 men and 45 women had a median age of 49 years (IQR 24-71). Median seizure time was 60 min (IQR 20-180), and 58 patients had seizures longer than 30 min. The SE was nonconvulsive in 16 (11%) patients and convulsive in 124 (89%), including 89 (64%) with tonic-clonic generalized seizures, 27 (19%) with partial seizures, 7 (5%) with myoclonic seizures, and 1 with tonic seizures. The most common causes of SE were cerebral insult in 53% and anticonvulsant drug withdrawal in 20% of patients. No cause was identified in 35% of patients. Median time from SE to treatment was 5 min (IQR 0-71). The SE was refractory in 35 (25%) patients. Mechanical ventilation was needed in 106 patients. Hospital mortality was 21%. By multivariate analysis, independent predictors of 30-day mortality were age (OR 1.03/year; 95% CI 1.00-1.06), GCS at scene (OR 0.84/point; 95% CI 0.72-0.98), continuous SE (OR 3.17; 95% CI 1.15-8.77), symptomatic SE (OR 4.08; 95% CI 1.49-11.10), and refractory SE (OR 2.83; 95% CI 1.06-7.54).
  
  
  CONCLUSIONS
  Mortality in SE patients remains high and chiefly determined by seizure severity. Further studies are needed to evaluate the possible impact of early maximal anticonvulsant treatment on outcomes.
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France. stlegriel@invivo.edu
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legriel
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bele
authors.forename: Jose
authors.initials: J
authors.lastname: Amaro
authors.forename: Pierre
authors.initials: P
authors.lastname: Fouet
authors.forename: Philippe
authors.initials: P
authors.lastname: Manet
authors.forename: François
authors.initials: F
authors.lastname: Hilpert
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D016638:Critical Illness; D004569:Electroencephalography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants