%0 Journal Article
%T Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit
%A O. H. Hernandez
%A J. F. Zapata
%A M. Jimenez
%A M. Massaro
%A A. Guerra
%A J. C. Arango
%A J. D. Ciro
%A H. Delgado
%A J. I. Suarez
%J Journal of Critical Care Medicine
%D 2014
%R 10.1155/2014/821462
%X 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 patientsĄŻ 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. 1. Introduction Status epilepticus (SE) is a medical emergency, due to significant morbidity and mortality and requires prompt attention and adequate management. In different series, the SE mortality varies between 17 and 26%, and approximately 10 to 23% of the patients that survived presented some degree of neurological impairment [1¨C4]. In the Intensive Care Unit (ICU) there are two groups of patients with SE: patients with multiple episodes of clinical seizures who have various response to initial management, and there are individuals admitted for other reasons who developed subclinical ictal episodes during their stay in the ICU. The latter is classified as nonconvulsive status epilepticus (NCSE) [1, 4, 5]. It is estimated that NCSE represents between 25 and 50% of all SE cases, but in the critically ill patient this entity could have a greater incidence. Various publications report that 10% of comatose patients suffer from NCSE, being the incidence much higher in the neurocritical care unit (NeuroICU), where about 34% of patients can have altered consciousness [6¨C11]. Continuous video electroencephalogram (cVEEG) monitoring is a necessary tool in patients
%U http://www.hindawi.com/journals/jccm/2014/821462/