title: Long-term outcome of refractory status epilepticus in adults: A retrospective population-based study.
abstract: Refractory status epilepticus (RSE) is a neurological emergency with significant morbidity and mortality. We aimed to analyze the long-term outcome of intensive care unit (ICU)-treated RSE and super-refractory status epilepticus (SRSE) patients in a population based cohort.
  
  
  
  A retrospective study of ICU- and anesthesia-treated RSE patients in Kuopio University Hospital's (KUH) special responsibility area hospitals in the central and eastern part of Finland from Jan. 1, 2010 to Dec. 31, 2012 was conducted. KUH's catchment area consists of five hospitals-one university hospital and four central hospitals-and covers a population of 840 000. We included all consecutive adult (16 years or older) RSE patients admitted in the participating ICUs during the 3-year period and excluded patients with postanoxic etiologies. We used a modified Rankin Scale (mRS) as a long-term (1-year) outcome measure: good (mRS 0-3, recovered to baseline function) or poor (mRS 4-6, major functional deficit or death).
  
  
  
  We identified 75 patients with ICU- and anesthesia-treated RSE, corresponding to an annual incidence of 3.0 (95% confidence interval (CI) 2.4-3.8). 21% of the patients were classified as SRSE, with the annual incidence being 0.6/100 000 (95% CI 0.4-1.0). For RSE, the ICU mortality was 0%, hospital mortality was 7% (95% CI 1.2%-12.8%) (n=5), and one-year mortality was 23% (CI 95% 13.4%-32.5%) (n=17). 48% (n=36) of RSE patients recovered to baseline, and 29% (n=22) showed neurological deficit at 1year. Poor outcome (mRS 4-6) was recorded for 52% (n=39) of the patients. Older age was associated with poorer outcome at 1year (p=0.03). For SRSE, hospital mortality was 6% (n=1) and 1-year mortality was 19% (n=3) (95%CI 0%-38.2%).
  
  
  
  During 1-year follow-up, nearly 50% of the ICU-treated RSE patients recovered to baseline function, whereas 30% showed new functional defects and 20% died. SRSE does not have a necessarily poorer outcome. The outcome is worse in older patients and in patients with progressive or fatal etiologies. SE should be treated with generalized anesthesia only in refractory cases after failure of adequately used first- and second-line antiepileptic drugs.
authors.affiliation: Department of Neurology, Neurocenter, Epilepsy Center, Kuopio University Hospital, Kuopio, Finland. Electronic address: anne-mari.kantanen@kuh.fi.
authors.forename: Anne-Mari
authors.initials: AM
authors.lastname: Kantanen
authors.affiliation: Intensive Care Unit, North Karelia Central Hospital, Joensuu, Finland and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Reinikainen
authors.affiliation: Intensive Care Unit, University of Eastern Finland, Kuopio, Finland and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Parviainen
authors.affiliation: Epilepsy Center, Neurocenter, Kuopio University Hospital and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Reetta
authors.initials: R
authors.lastname: Kälviäinen
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D015331:Cohort Studies; D018672:Community Health Planning; D018450:Disease Progression; D004569:Electroencephalography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Classification; Definition; Epilepsy; Etiology; Incidence; International league against epilepsy (ILAE); Mortality; Predictor; Refractory status epilepticus (RSE); Risk factor; Semiology; Super-refractory