title: Prognosis and predictors of outcome of refractory generalized convulsive status epilepticus in adults treated in neurointensive care unit.
abstract: OBJECTIVE
  To evaluate the etiological profile, clinical characteristics and outcome of patients with refractory generalized convulsive status epilepticus treated in Neurological Intensive Care Unit (NICU).
  
  
  METHODS
  In this open cohort study, data of 126 patients, aged 18 years and above, with convulsive status epilepticus (SE) admitted in NICU was collected. Status epilepticus was defined as seizures lasting for more than five minutes without regaining consciousness. Refractory SE (RSE) was defined as SE refractory to 2 antiepileptic drugs and requiring anesthetic agents for seizure control. Survival and regression analysis were done to analyze the outcome and factors predicting outcome respectively in the study population.
  
  
  RESULTS
  Out of 126 patients, 81 patients had non -refractory status epilepticus (NRSE); 45 (35.7%) had RSE. Acute symptomatic etiology was noted in 58.6% of entire cohort. Significantly higher percentage of patients with RSE had an etiology of CNS infections than NRSE group (44.4% vs. 23.5%; P=0.0171). Amongst the CNS infections, viral encephalitis was significantly higher in RSE than NRSE patients (31% vs. 6.2%; P=0.0004). All the patients with RSE required mechanical ventilation. Overall mortality was 19%. The mortality in RSE was 42% (19 out of 45), significantly higher when compared to NRSE where only 6% (5 out of 81) died. On logistic regression, the only predictor of death was fever with an odds ratio of 8.55 (P=0.024).
  
  
  CONCLUSIONS
  CNS infections, especially viral encephalitis and complications of mechanical ventilation were significantly higher in adult RSE patients. Although mortality is higher in adult patients with RSE, etiology does not contribute to mortality; however fever predicts mortality in these patients. Aggressive management of underlying etiology and prevention of systemic complications may improve outcome in adult RSE patients.
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad500 003, Andhra Pradesh, India.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad500 003, Andhra Pradesh, India. Electronic address: sita_js@hotmail.com.
authors.forename: Sita
authors.initials: S
authors.lastname: Jayalakshmi
authors.affiliation: Department of Critical Care, Krishna Institute of Medical Sciences, Minister Road, Secunderabad500 003, Andhra Pradesh, India.
authors.forename: Sambit
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad500 003, Andhra Pradesh, India.
authors.forename: Surath
authors.initials: S
authors.lastname: Mohandas
mesh_terms: D000328:Adult; D002494:Central Nervous System Infections / Q000150:complications*; D004351:Drug Resistance; D018792:Encephalitis, Viral / Q000150:complications; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012121:Respiration, Artificial; D013226:Status Epilepticus / Q000209:etiology / Q000401:mortality / Q000628:therapy
keywords: Encephalitis; Mortality; Outcome; Refractory status epilepticus