Refractory Status Epilepticus: Risk Factors and Analysis of Intubation in the Multicenter SENSE Registry

Area of Science:

• Neurology
• Critical Care Medicine
• Clinical Research

Background:

• Refractory status epilepticus (RSE) presents significant morbidity and mortality.
• Current RSE management often involves therapy escalation and intubation, with limited retrospective data from intensive care units.
• A large, multicenter cohort is needed to describe routine-care management and analyze RSE determinants and outcomes.

Purpose of the Study:

• To describe routine-care management of RSE in a large multicenter cohort.
• To analyze factors influencing the development of RSE.
• To investigate outcomes associated with RSE and its management.

Main Methods:

• Post hoc analysis of an observational, prospective cohort study including 996 adult patients with incident status epilepticus (SE).
• RSE defined as ongoing SE despite two antiseizure medications; patients intubated during first- or second-line treatment were excluded.
• Investigated variables included demographics, SE Severity Score, etiology, guideline-compliant treatment, survival, and modified Rankin Scale (mRS) at discharge.

Main Results:

• 54.7% of patients developed RSE, associated with higher baseline mRS and treatment deviation from guidelines.
• Good outcomes (mRS 0-2 or no worsening) were observed in 52.7% of refractory patients.
• Factors correlating with good outcomes included lower SE severity, absence of acute etiology, adequate first-line benzodiazepine dose, shorter SE and hospitalization durations, and lack of intubation.

Conclusions:

• Identified variables associated with RSE, some potentially preventable.
• Over 70% of RSE cases were managed without intubation.
• Focal RSE without deep consciousness impairment in older patients may be treatable outside ICUs.