title: A one-year prospective study of refractory status epilepticus in Modena, Italy.
abstract: Refractory status epilepticus (RSE) is a particular critical condition characterized by seizures that continue despite the use of first- and second-line therapies and by high mortality. To date, only one prospective study investigated clinical features and prognostic factors in RSE. In this study, we performed a one-year prospective survey to identify clinical features, outcomes, and variables associated with the development of RSE in the adolescent and adult population of Modena, northern Italy. We observed 83 episodes of SE in 83 patients. In 31% of the cases, third-line therapy (anesthetic drug) was needed. Among this group, 14% resolved and were classified as RSE, while, in 17%, seizures recurred at withdrawal of anesthetics and were classified as super-RSE. The development of RSE/super-RSE was associated with a stuporous/comatose state at presentation and with the absence of a previous history of epilepsy. Refractory status epilepticus/super-refractory status epilepticus showed a worse outcome compared with responsive SE: 54% versus 21% for 30-day mortality; 19% versus 56% for a return to baseline condition. This prospective study confirms stupor/coma at onset as a relevant clinical factor associated with SE refractoriness. We observed a rate of RSE comparable with previous reports, with high mortality and morbidity. Mortality in the observed RSE was higher than in previous studies; this result is probably related to the low rate of a previous epilepsy history in our population that reflects a high incidence of acute symptomatic etiologies, especially the inclusion of patients with postanoxic SE who have a bad prognosis per se. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy. Electronic address: giovannini.giada@gmail.com.
authors.forename: Giada
authors.initials: G
authors.lastname: Giovannini
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Monti
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Michela M
authors.initials: MM
authors.lastname: Polisi
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mirandola
authors.affiliation: Intensive Care Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marudi
authors.affiliation: Emergency Department, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pinelli
authors.affiliation: Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Valzania
authors.affiliation: Intensive Care Unit, AO Policlinico di Modena, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Nichelli
authors.affiliation: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena, Italy; Neurology Unit, NOCSAE Hospital, ASL Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Meletti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Disability; Mortality; Predictors; Refractory status epilepticus; Status epilepticus; Super-refractory status epilepticus