OUR CASE
Sharon made a rapid and full recovery from her refractory status epilepticus.
She was discharged from ICU on day 2 on regular diazepam with ongoing review and follow up by the Neurology team planned.
The levetiracetam was stopped in the context of her mood disorder diagnosis.
Patient outcomes
> Outcomes after presentation with status epilepticus are incredibly varied.
Overall mortality for SE is around 8%
Overall mortality for RSE is 17%
Overall mortality for SRSE is 40%
Aetiology of seizures
> Hypoxic brain injury carries worst prognosis
> CNS infection causing seizures also carries a poor prognosis
> Withdrawal from or subtherapeutic anti-seizure medications carries a much better prognosis
Higher Age
More comorbidities
> e.g. existing metastatic cancer significantly increases mortality
EEG pattern
e.g. spontaneous burst suppression on EEG is a poor prognostic sign
Convulsive SE has a worse prognosis than NCSE
SRSE has a 40% mortality
Some patients may have good functional recovery after weeks to even months of general anesthesia for SRSE.
Among those who survive, 60 % stabilize or improve their functional status over time REF
22 % with SRSE are able to achieve independence REF
10 % return to their premorbid functional status REF
The high mortality rates in SRSE patients are largely driven by either changes in the goals of care or complications of treatment and critical illness.
Therefore, the relationship between duration of SRSE and outcome might be a result of accumulating systemic complications rather than the seizure itself REF
Transition to palliative care is usually guided by family members or medical staff after weeks or months of refractory seizures, when treatment options have been exhausted.