Evaluating Treatment Dynamics in Refractory Status Epilepticus: A Retrospective Observational Cohort Study

Area of Science:

• Neurology
• Critical Care Medicine
• Pharmacology

Background:

• Status epilepticus (SE) is a critical neurological emergency with significant morbidity and mortality.
• Optimal treatment strategies for refractory SE (RSE), including repeat IV-antiseizure medications (IV-ASMs) or IV-anesthesia (IVA), lack clear guidance.
• This study investigates real-world RSE management and outcomes in hospitalized US patients.

Purpose of the Study:

• To analyze treatment patterns for refractory SE (RSE).
• To compare outcomes between RSE patients receiving IV-anesthesia (IVA) and those not.
• To evaluate the impact of escalating IV-antiseizure medication (IV-ASM) doses in RSE.

Main Methods:

• Retrospective analysis of the PINC AI™ Healthcare Database (2018-2022).
• Categorization of RSE encounters into RSE-no IVA and RSE-IVA groups.
• Stratification of RSE-no IVA by the number of IV-ASMs administered (2 vs. ≥3).

Main Results:

• Refractory SE (RSE) accounted for 44% of SE episodes.
• RSE patients receiving IV-anesthesia (IVA) had longer ICU and hospital stays and higher mortality (25% vs. 12%) compared to those without IVA.
• Administration of ≥3 IV-antiseizure medications (IV-ASMs) was associated with increased ICU admission and longer hospital LOS compared to 2 IV-ASMs.

Conclusions:

• Significant heterogeneity exists in RSE treatment sequencing and escalation timing.
• Increased IV-ASM use and IVA exposure correlate with worse outcomes and higher healthcare utilization.
• There is an urgent need for more effective and rapid anti-SE treatments.