Clinical characteristics, etiology and outcome of new onset refractory status epilepticus in adults

We analyzed clinical features and predictors of outcome in adult patients with new-onset refractory status epilepticus(NORSE).

In this retrospective cohort, we analyzed the data of 72 patients with NORSE followed-up for two or more years. Outcome was assessed by Glasgow Outcome Scale(GOS) at discharge and latest follow-up.

Mean age of the population was 35.13 ± 16.42 years and average follow-up was 60.34 ± 18.12 months. Average length of stay in hospital was 19.62 ± 14.68 days and mean ICU stay was14.43 ± 13.89 days. Of 72 patients with NORSE, 37(51.3%) patients progressed to super-refractory status epilepticus(SRSE). The most common etiology was cryptogenic(54%) followed by viral encephalitis(25%). Overall mortality was 27.8%. At discharge, 37 of 72 cases(51.4%) achieved a poor outcome (GOS 1-3). Among the survivors(n = 52), functional outcome improved over time and 84.6%(n = 44) achieved good outcome(GOS 4-5); however significant cognitive impairment was reported in 29(56%) and drug-resistant epilepsy in 31(60%). Although none of the factors predicted poor GOS outcome at discharge; etiology of viral encephalitis was associated with poor outcome at latest follow-up. Viral encephalitis, not able to achieve burst suppression on cEEG, medical complications and progression to SRSE predicted mortality during hospital stay.

Despite a prolonged clinical course and high mortality rate, more than 80% of adult survivors with NORSE attained a favourable functional outcome at long-term follow-up. None of the factors predicted the functional outcome at discharge; viral encephalitis was associated with poor outcome at latest follow-up. Significant cognitive impairment and drug-resistant epilepsy were reported in more than 50% of the survivors.