Long-term outcome in new onset refractory status epilepticus: a retrospective study.

Stretti, Federica; Bögli, Stefan Yu; Casagrande, Francesca; Eisele, Amanda; Galovic, Marian; Keller, Emanuela; Brandi, Giovanna

Background New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series of patients with NORSE. Methods Overall, 283 adults were admitted with status epilepticus (SE) to the Neurocritical Care Unit of the University Hospital Zurich, Switzerland, between 01.2010 and 12.2022. Of them, 25 had a NORSE. We collected demographic, clinical, therapeutic and outcome data. Descriptive statistics was performed. Results Most patients were female (68%), previously healthy (Charlson comorbidity index 1 [0–4]) and relatively young (54±17 years). 96% presented with super-refractory SE. Despite extensive workup, the majority (68%) of cases remained cryptogenic. Most patients had a long and complicated ICU stay. The in-hospital mortality was 36% (n=9). The mortality at last available follow-up was 56% (n=14) on average 30 months after ICU admission. The cause of in-hospital death for 89% (n=8) of the patients was the withholding/withdrawing of therapies. Medical staf except for one patient triggered the decision. The end of life (EOL) decision was taken 29 [12–51] days after the ICU admission. Death occurred on day 6 [1–8.5] after the decision was taken. The functional outcome improved over time for 13/16 (81%) hospital survivors (median mRS at hospital discharge 4 [3.75–5] vs. median mRS at last available follow-up 2 [1.75–3], p<0.001). Conclusions Our data suggest that the long-term outcome can still be favorable in NORSE survivors, despite a prolonged and complicated ICU stay. Clinicians should be careful in taking EOL decisions to avoid the risk of a self-fulflling prophecy. Our results encourage clinicians to continue treatment even in initially refractory cases.

Critical Care, 2024, Vol 28, Issue 1, p1

1364-8535

Academic Journal

10.1186/s13054-024-04858-7