Functional outcome of prolonged refractory status epilepticus.
BACKGROUND
To characterize etiology, clinical course and outcomes of patients in prolonged refractory status epilepticus (PRSE) and looking for prognostic factors.


METHODS
Retrospective study conducted in patients hospitalized from January 1, 2001 to December 31, 2011 in 19 polyvalent intensive care units in French university and general hospitals. Patients were adults with a generalized convulsive refractory status epilepticus that lasted more than seven days, despite treatment including an anesthetic drug and mechanical ventilation. Patients with anoxic encephalopathy were excluded. Follow-up phone call was used to determine functional outcome using modified Rankin Scale (mRS) with mRS 0-3 defining good and mRS 4-6 poor outcome.


RESULTS
78 patients (35 female) were included. Median age was 57 years. Causes of status epilepticus were various, mainly including prior epilepsy (14.1%), CNS infection (12.8%), and stroke (12.8%). No etiology was found in 27 (34.6%) patients. PRSE was considered controlled in only 53 (67.9%) patients after a median duration of 17 (IQR 12-26) days. The median length of ICU stay was 28 (19-48) days. Forty-one (52.5%) patients died in the ICU, 26 from multiple organ failure, 8 from care withdrawal, 2 from sudden cardiac arrest, 1 from brain death and 4 from unknown causes. PRSE was previously resolved in 20 patients who died in the ICU. At one-year follow-up, there were 12 patients with good outcome and 58 with poor outcome and 8 lost of follow-up. On multivariate analysis, only vasopressor use was a predictor of poor outcome (OR 6.54; 95%CI 1.09-39.29; p = 0.04).


CONCLUSIONS
Poor outcome was observed in about 80% of this population of PRSE. Most patients died from systemic complications linked to their ICU stay. Some patients can recover satisfactorily over time though we did not identify any robust factor of good outcome.
Service de Réanimation médicale, Hôpital Central, CHU de Nancy, Nancy, France. lai.alexandre93@gmail.com.
Alexandre
A
Lai
Service de Réanimation médico-chirurgicale, CHI de Poissy-Saint Germain en Laye, Poissy, France. outin@chi-poissy-st-germain.fr.
Hervé D
HD
Outin
Service de Réanimation Polyvalente, CHU Réunion, Saint Denis de la Réunion, France. jabot974@gmail.com.
Julien
J
Jabot
Service de Réanimation et de Toxicologie, CHU Lariboisière, Université Paris VI, Paris, France. bruno.megarbane@lrb.ap-hop-paris.fr.
Bruno
B
Mégarbane
Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes, France. stephanegaudry@gmail.com.|Univ Paris Diderot, UMRS 1123, Paris, France. stephanegaudry@gmail.com.
Stéphane
S
Gaudry
Service de Réanimation Médicale, CHU de Poitiers, Poitiers, France. r.coudroy@yahoo.fr.
Rémi
R
Coudroy
Service de Réanimation Polyvalente, CHR de Metz-Thionville, Metz, France. gus_louis@yahoo.fr.
Guillaume
G
Louis
Service de Réanimation Médicale, Hôpital de Strasbourg-Hautepierre, Université Louis Pasteur, Strasbourg, France. francis.schneider@chru-strasbourg.fr.
Francis
F
Schneider
Service de Réanimation Polyvalente, CH de St Brieuc, St Brieuc, France. nicolas.barbarot@ch-stbrieuc.fr.
Nicolas
N
Barbarot
Service de Réanimation, Hôpital Nord, CHU de Marseille, Marseille, France. antoine.roch@mail.ap-hm.fr.
Antoine
A
Roch
Service de Réanimation Médicale et de Médecine Hyperbare, CHU et Université d'Angers, Angers, France. nicolas.lerolle@univ-angers.fr.
Nicolas
N
Lerolle
Service de Réanimation Médico-chirurgicale, Garches, France. davidluis.fr@gmail.com.
David
D
Luis
Service de Réanimation Polyvalente, Hôpital Roger Salengro, CHU de Lille, Lille, France. ffourrier@nordnet.fr.
François
F
Fourrier
Service de Réanimation Médicale, CHU de Brest, Brest, France. anne.renault@chu-brest.fr.
Anne
A
Renault
Service de Réanimation Médicale, Hôpital Edouard Herriot, Lyon, France. laurent.argaud@chu-lyon.fr.
Laurent
L
Argaud
Service de Réanimation Médico-chirurgicale, Hôpital Raymond Poincaré, Garches and Université de Versailles St Quentin en Yvelines, Garches, France. tarek.sharshar@rpc.aphp.fr.
Tarek
T
Sharshar
Service de Réanimation médicale, Hôpital Central, CHU de Nancy, Nancy, France. s.gibot@chu-nancy.fr.
Sébastien
S
Gibot
Service de Réanimation médicale, Hôpital Central, CHU de Nancy, Nancy, France. pe.bollaert@chu-nancy.fr.
Pierre-Edouard
PE
Bollaert
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D020127:Recovery of Function; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome