Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome.
Retrospective assessment of a prospectively collected cohort.
Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013.
Measurements and Main Results:
We recorded prospectively demographics, clinical status epilepticus features, treatment
, and outcome at discharge and retrospectively medical comorbidities, hospital stay
, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with therapeutic coma. Therapeutic coma was associated with poorer outcome in the whole cohort (relative risk ratio for new disability, 6.86; 95% CI, 2.84–16.56; for mortality
, 9.10; 95% CI, 3.17–26.16); the effect was more important in patients with complex partial compared with generalized convulsive or nonconvulsive status epilepticus in coma. Prevalence of infections
was higher (odds ratio, 3.81; 95% CI, 1.66–8.75), and median hospital stay
in patients discharged alive was longer (16 d [range, 2–240 d] vs 9 d [range, 1–57 d]; p
< 0.001) in subjects managed with therapeutic coma.
This study provides class III evidence that therapeutic coma is associated with poorer outcome after status epilepticus; furthermore, it portends higher infection rates and longer hospitalizations. These data suggest caution in the straightforward use of this approach, especially in patients with complex partial status epilepticus.