Clinical and electrophysiological predictors of refractory status epilepticus: a prospective South Asian cohort

To evaluate clinical determinants of refractoriness and outcome in status epilepticus (SE) in a prospective low- and middle-income country (LMIC) cohort.

In this single-centre prospective cohort study, 97 consecutive SE patients were classified as non-refractory status (NRSE, n = 50), refractory (RSE, n = 31), or super-refractory SE (SRSE, n = 16). A single 21 channel video-EEG was done within 24 h of presentation to the hospital. Clinical context, preexisting epilepsy history, etiology, Status Epilepticus Severity Score (STESS) and EEG findings were recorded, and outcome was assessed through in-hospital mortality.

The median age of our cohort was 32 years; most common etiologies were remote symptomatic (68%), acute symptomatic (19%) and progressive symptomatic (5%). Patients with drug-sensitive epilepsy (DSE) showed low refractoriness and mortality (29%, 6%), whereas drug-resistant epilepsy and new-onset status epilepticus (NOSE) were more likely to be refractory (68% and 70% respectively) and had higher mortality (26% and 30% respectively). Overall mortality was 16.5%, increasing stepwise from 4% (NRSE) to 13% (RSE) to 63% (SRSE; p < 0.001). STESS discriminated between non-survivors and survivors (median 3 vs 0; p < 0.001). Among 85 patients with available EEG, periodic discharges (PDs) were associated with 71% mortality (p < 0.001).

Status Epilepticus in the setting of DSE carries a favourable prognosis, while DRE and NOSE confer refractoriness. A short-term early EEG performed in the first 24 h is associated with refractoriness and its exact role warrants further studies.