title: Preliminary results of the global audit of treatment of refractory status epilepticus.
abstract: The treatment of refractory and super refractory status epilepticus is a "terra incognita" from the point of view of evidence-based medicine. As randomized or controlled studies that are sufficiently powered are not feasible in relation to the many therapies and treatment approaches available, we carried out an online multinational audit (registry) in which neurologists or intensivists caring for patients with status epilepticus may prospectively enter patients who required general anesthesia to control the status epilepticus (SE). To date, 488 cases from 44 different countries have been collected. Most of the patients had no history of epilepsy and had a cryptogenic etiology. First-line treatment was delayed and not in line with current guidelines. The most widely used anesthetic of first choice was midazolam (59%), followed by propofol and barbiturates. Ketamine was used in most severe cases. Other therapies were administered in 35% of the cases, mainly steroids and immunotherapy. Seizure control was achieved in 74% of the patients. Twenty-two percent of patients died during treatment, and four percent had treatment actively withdrawn because of an anticipated poor outcome. The neurological outcome was good in 36% and poor in 39.3% of cases, while 25% died during hospitalization. Factors that positively influenced outcome were younger age, history of epilepsy, and low number of different anesthetics tried. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Unit of Neurology "A", University Hospital of Verona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ferlisi
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hocker
authors.affiliation: UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Grade
authors.affiliation: Universitätsklinik für Neurologie, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Trinka
authors.affiliation: UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK. Electronic address: s.shorvon@ion.ucl.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Shorvon
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000778:Anesthetics, Dissociative / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use*; D001463:Barbiturates / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D000069279:Drug Resistant Epilepsy / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D017408:Guidelines as Topic; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D008485:Medical Audit; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D013226:Status Epilepticus / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D001463:Barbiturates; D007649:Ketamine; D008874:Midazolam; C032232:barbituric acid; D015742:Propofol
keywords: Global audit; Refractory; Registry; Status epilepticus; Super refractory; Treatment