title: Determinants and predictors of outcome in super refractory status epilepticus--a developing country perspective.
abstract: OBJECTIVE
  Super refractory status epilepticus (SRSE) is a recent entity. There is limited information about the etiology and outcome of SRSE from developing countries.
  
  
  OBJECTIVE
  We evaluated determinants and predictors of outcome in patients with convulsive SRSE in Indian population.
  
  
  METHODS
  In this open cohort study, data of patients with convulsive SE admitted in neurointensive care unit (NICU) from 2005 to 2013 was retrospectively analyzed. Regression and survival analysis was done for outcome of patients divided into non refractory SE (NRSE), refractory SE (RSE), and SRSE groups.
  
  
  METHODS
  The primary outcome for analysis was in hospital mortality. Also functional outcome at 6 months was graded according to the Glasgow outcome scale (GOS), and classified as good (GOS 4 and 5) and poor (GOS 1, 2 and 3) outcome groups.
  
  
  RESULTS
  Out of 177 patients with SE, 105 (59.3%) had NRSE; 72 (40.7%) had RSE of which 30 (16.9% of 177) were sub-classified as SRSE. SRSE was frequent (39%) in children (p<0.01), elderly (21.7%; p<0.003), and in incident SE (82.1%, p=0.05). Encephalitis was the commonest etiology in RSE (30.9%, p=0.015), SRSE (66.7%, p<0.001) than NRSE (12.3%). Encephalitis (β=8.250 (1.8-37.82); p=0.007) was the determinant of the progression of SE to SRSE. Overall mortality was 19.2%, highest in SRSE (40.0%) followed by RSE (35.7%), both significantly (p<0.001) higher than NRSE (6.7%). Mortality was high in patients with encephalitis than other etiologies (39.1% vs. 12.1%; p=0.001). Acidosis predicted mortality in the entire cohort (β=7.313 (1.6-32.58); p=0.009); however none of the variables predicted mortality in SRSE patients. At 6 months follow up only 33.3% of patients with SRSE were in GOS good outcome group when compared to RSE (33.3% vs. 57.1%; p=0.055), and NRSE (33.3% vs. 79.1%; p<0.0001).
  
  
  CONCLUSIONS
  SRSE is common in children, elderly, and incident SE. Encephalitis was the determinant of progression of SE to SRSE. None of the variables predicted mortality in SRSE patients. Sixty percent of patients with SRSE survived and one third had good outcome. Therefore one should continue the care inspite of weeks of SE.
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad 03, Andhra Pradesh, India. Electronic address: sita_js@hotmail.com.
authors.forename: Sita
authors.initials: S
authors.lastname: Jayalakshmi
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad 03, Andhra Pradesh, India.
authors.forename: Devashish
authors.initials: D
authors.lastname: Ruikar
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad 03, Andhra Pradesh, India.
authors.forename: Sudhindra
authors.initials: S
authors.lastname: Vooturi
authors.affiliation: Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Suvarna
authors.initials: S
authors.lastname: Alladi
authors.affiliation: Department of Critical Care, Krishna Institute of Medical Sciences, Minister Road, Secunderabad 03, Andhra Pradesh, India.
authors.forename: Sambit
authors.initials: S
authors.lastname: Sahu
authors.affiliation: Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.
authors.forename: Subhash
authors.initials: S
authors.lastname: Kaul
authors.affiliation: Department of Neurology, Krishna Institute of Medical Sciences, Minister Road, Secunderabad 03, Andhra Pradesh, India.
authors.forename: Surath
authors.initials: S
authors.lastname: Mohandas
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology; D011237:Predictive Value of Tests; D013226:Status Epilepticus / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Acidosis; Encephalitis; Mortality; Status epilepticus; Super refractory status epilepticus