Management Challenges and Clinical Characteristics of Refractory Status Epilepticus in Mexico: A 102 Patient...

There is limited real-world evidence on the diagnosis, treatment, and outcomes of refractory status epilepticus (RSE) in Latin America. This study describes the clinical characteristics, management, and outcomes of RSE in a tertiary neurological intensive care unit (NICU) in Mexico. We conducted a retrospective cohort study of adults (≥ 18 years) with RSE admitted from 2010 to 2022. All patients were initially analyzed as a single cohort; a prespecified secondary analysis stratified patients by preexisting epilepsy and identified those with new-onset RSE (NORSE). Patients were identified via electronic medical records and met the International League Against Epilepsy (ILAE) definition. Clinical, imaging, laboratory, and EEG data were collected. Outcomes included seizure cessation, functional status at NICU discharge (mRS), and prognostic scores (STESS and END-IT). Statistical analysis involved descriptive measures, chi-square/Fisher's exact tests, t-test or Mann-Whitney U test, and multinomial logistic regression. Significance was set at p < 0.05. We analyzed 102 patients with RSE; 52.9% were women, median age 34 (26-44) years. Preexisting epilepsy was present in 70.6%, and 29.4% had NORSE. Most common etiologies were infections (23.5%), structural/vascular (22.5%), and treatment-related (16.7%). EEG most commonly showed slowing; interictal epileptiform discharges appeared in 27.7%. Treatment was heterogeneous; 82.4% required third-line therapy. Median hospitalization was 21.5 days, with mechanical ventilation averaging 8 days. Resolution occurred in 87.3%. One patient underwent surgery, without complications. Preexisting epilepsy was significantly associated with prior SE (p = 0.011), resolution (p = 0.001), unfavorable mRS (p = 0.046), and higher STESS (p = 0.001) and END-IT (p = 0.021) scores. END-IT also correlated with third-line treatment (p < 0.001). This study offers real-world insights into RSE in a resource-limited setting, highlighting preventable causes, management complexity, and high care demands. Despite limitations, favorable outcomes are often achievable.