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Functional outcome after convulsive status epilepticus

Legriel, Stéphane MD; Azoulay, Elie MD, PhD; Resche-Rigon, Matthieu MD, PhD; Lemiale, Virginie MD; Mourvillier, Bruno MD; Kouatchet, Achille MD; Troché, Gilles MD; Wolf, Manuel MD; Galliot, Richard MD; Dessertaine, Géraldine MD; Combaux, Danièle MD; Jacobs, Frederic MD; Beuret, Pascal MD; Megarbane, Bruno MD, PhD; Carli, Pierre MD; Lambert, Yves MD; Bruneel, Fabrice MD; Bedos, Jean-Pierre MD, PhD

doi: 10.1097/CCM.0b013e3181f859a6
Continuing Medical Education Articles

Objectives: Few outcome data are available about convulsive status epilepticus managed in the intensive care unit. We studied 90-day functional outcomes and their determinants in patients with convulsive status epilepticus.

Design: Two hundred forty-eight convulsive status epilepticus patients admitted to 18 intensive care units in 2005–2007 were included in a prospective observational cohort study. The main outcome measure was a Glasgow Outcome Scale score of 5 (good recovery) on day 90.

Main Results: Convulsive status epilepticus occurred out of hospital in 177 (67%) patients, and all but 15 patients were still seizing at medical team arrival. The median time from convulsive status epilepticus onset to anticonvulsant drug initiation was 40 mins (interquartile range, 5–80). Total seizure duration was 85 mins (interquartile range, 46.5–180). Convulsive status epilepticus was refractory in 49 (20%) patients. The most common causes of convulsive status epilepticus were anticonvulsive agent withdrawal (36.4%) in patients with previous epilepsy and stroke (27.7%) in inaugural convulsive status epilepticus. Mechanical ventilation was needed in 210 (85%) patients. On day 90, 42 (18.8%) patients were dead, 87 (38.8%) had marked functional impairments (Glasgow Outcome Scale score, 2–4), and 95 (42.4%) had a good recovery (Glasgow Outcome Scale score, 5). Factors showing independent positive associations with poor outcome (Glasgow Outcome Scale score, <5) were older age (odds ratio, 1.04/year; 95% confidence interval, 1.02–1.05; p = .0005), cerebral insult (odds ratio, 2.70; 95% confidence interval, 1.37–5.26; p = .007), longer seizure duration (odds ratio, 1.72/120 min; 95% confidence interval, 1.05–2.86; p = .03), on-scene focal neurologic signs (odds ratio, 2.08; 95% confidence interval, 1.03–4.16; p = .04), and refractory convulsive status epilepticus (odds ratio, 2.70; 95% confidence interval, 1.02–7.14; p = .045).

Conclusions: Ninety days after intensive care unit admission for convulsive status epilepticus, half the survivors had severe functional impairments. Longer seizure duration, cerebral insult, and refractory convulsive status epilepticus were strongly associated with poor outcomes, suggesting a role for early neuroprotective strategies.

Doctor (SL), Intensive Care Department, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay, France; Professor (EA), Intensive Care Department, CHU Saint Louis, Paris, France; Doctor (MR-R), Biostatistics Department, CHU Saint Louis, Paris, France; Doctor (VL), Intensive Care Department, CHU Saint Louis, Paris, France; Doctor (BMo), Intensive Care Department, CHU Bichat, Paris, France; Doctor (AK), Intensive Care Department, CHU Angers, Angers, France; Doctor (GT), Intensive Care Department, Hospital de Versailles, Le Chesnay, France; Medical Doctor (MW), Intensive Care Department, CHU Orléans, Hopital de la Source, Orléans, France; Doctor (RG), Foch Hospital, Suresnes, France; Doctor (GD), Intensive Care Department, CHU Grenoble, Grenoble, France; Doctor (DC), Intensive Care Department, Centre Hospitalier de Compiègne, Compiègne, France; Doctor (FJ), Service de Réanimation Médicale, Hospital Antoine Beclere, Assistance Publique–Hôpitaux de Paris, Clamart, France; Doctor (PB), Intensive Care Department, Centre Hospitalier de Roanne, Roanne, France; Professor of Critical Care Medicine (BMe), Paris-Diderot University, Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Paris, France; Professor (PC), CHU Necker, Service d'Aide Médicale Urgente 75, Paris, France; Doctor (YL), Centre Hospitalier de Versailles, André Mignot Hospital, Service d'Aide Médicale Urgente 78, Le Chesnay, France; Doctor (FB), Intensive Care Department, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay, France; and Doctor (J-PB), Intensive Care Department, Centre Hospitalier de Versailles, André Mignot Hospital, Le Chesnay, France.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ccmjournal.com). Supplemental data can be viewed here (Supplemental Digital Content 1, http://links.lww.com/CCM/A168).

Supported, in part, by a grant from the publically funded institution Assistance Publique, Hôpitaux de Paris (PHRC AOM 09180).

Drs. Legriel and Bedos conceived, designed, and supervised the trial. Dr. Legriel obtained funds from the French Ministry of Health to undertake the study. All the investigators collected the data, and Dr. Legriel coordinated the data collection. Drs. Legriel, Azoulay, and Resche-Rigon analyzed and interpreted the data. Dr. Resche-Rigon was in charge of statistical expertise. Drs. Legriel, Azoulay, and Jacobs wrote the first draft of the paper. All authors approved the final version of the report.

All participating hospitals and intensive care units are listed in the Appendix.

For information regarding this article, E-mail: slegriel@ch-versailles.fr

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins