Table of Contents
Journal of Critical Care Medicine
Volume 2014, Article ID 821462, 9 pages
http://dx.doi.org/10.1155/2014/821462
Clinical Study

Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

1Instituto Neurologico de Colombia, Neurological Intensive Care Unit, Calle 55 No. 46-36, 050012 Medellín, Colombia
2Instituto Neurologico de Colombia, Clinical Neurophysiology Unit, Medellin, Colombia
3Instituto Neurologico de Colombia, Research and Education Department, Medellin, Colombia
4Baylor College of Medicine Vascular Neurology and Neurocritical Care Division, Department of Neurology, Houston, TX, USA

Received 2 May 2013; Revised 30 July 2013; Accepted 12 August 2013; Published 2 January 2014

Academic Editor: Marieke Van Zoelen

Copyright © 2014 O. H. Hernandez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.