Status epilepticus without impairment of consciousness: Long-term outcomes according to duration

• Published in: Epilepsy & behavior Vol. 120; p. 108007
• Main Authors: Santamarina, E., Parejo-Carbonell, B., Abraira, L., Gutiérrez-Viedma, A., Fonseca, E., Seijo, I., Abarrategui, B., Salas-Puig, X., Quintana, M., Toledo, M., García-Morales, I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2021
• Subjects: Outcome; Status epilepticus; Time-to-resolution; Status epilepticus; Outcome; Time-to-resolution
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2021.108007

•Time-to-resolution is key to outcome in focal SE without impaired consciousness.•Long duration, etiology, and possible complications worsen the outcome at discharge.•Duration >100 h and etiology predict a poor outcome at long-term follow-up.
The point after which non-convulsive status epilepticus (NCSE) can cause permanent damage remains to be elucidated. The aim of this study was to analyze the association between time to resolution and long-term outcomes in NCSE.
We performed a retrospective study of all patients with focal NCSE without consciousness impairment at two tertiary care hospitals in Spain. All the data were registered prospectively and the study period was December 2014–May 2018. We collected information on demographics, SE etiology, time to administration of different lines of treatment, time to NCSE resolution, and outcomes at discharge, 1 year, and 4 years. Clinical outcome was prospectively categorized as good (return to baseline function) or poor (new disability and death).
Seventy-four patients with a mean (±SD) age of 63.4 ± 17.5 years and a mean follow-up time of 2.4 ± 2.2 years were studied. A poor outcome at discharge was associated with a potentially fatal etiology (p < 0.001), EMSE score (Epidemiology-based Mortality Score in Status Epilepticus) (p = 0.012), lateral periodic discharges on EEG (p = 0.034), and occurrence of major complications during hospitalization (p = 0.007). An SE duration of >100 h was clearly associated with a worse outcome (p < 0.001). In the multiple regression analysis, the only independent predictors of a poor outcome at discharge were an SE duration of >+100 hours (p = 0.001), a potentially fatal etiology (p = 0.001), and complications during hospitalization (p = 0.010). An SE duration of >100 hours retained its value as the optimal cutoff point for predicting poor outcomes at both 1 year (p = 0.037) and 4 years (p = 0.05). Other predictors of poor long-term outcomes were a potentially fatal etiology (p < 0.001) and EMSE score (p = 0.034) at 1 year, and progressive symptomatic etiology at 4 years (p = 0.025).
In patients with focal NCSE without consciousness impairment, a potentially fatal etiology and an SE duration of >100 h were associated with poor short-term and long-term outcomes.