Encephalitis a risk factor for refractory status epilepticus

Authors examining the risk factors and prognosis of refractory status epilepticus (RSE) identify encephalitis-associated status epilepticus (SE) as a predictor for RSE. They suggest rapid treatment escalation in these patients to avoid complications such as symptomatic epilepsy.The authors retrospectively analysed all SE episodes treated in their neurological intensive care unit over a ten-year period. They compared the predictors and prognosis of RSE and non-RSE and identified cases where symptomatic epilepsy resulted from the episode. RSE was defined as failure of two anticonvulsants (a benzodiazepine and phenytoin/fosphenytoin) in adequate doses, regardless of the duration of status activity.Of 83 SE episodes, 43% were refractory to first-line anticonvulsants, the authors report. Encephalitis was significantly more often the primary cause of RSE, whereas low levels of antiepileptic drugs were significantly more often associated with non-RSE. Additionally, hyponatraemia within the first 24 hours after onset of status activity was significantly more often associated with RSE.When investigating the outcomes in 17 patients with no previous history of epilepsy, the authors found that symptomatic epilepsy developed significantly more often following RSE (87.5%) than following non-RSE (22.2%). They explain, "This finding was independent of the type of SE. The current data suggest at least a prominent contribution of SE itself to the process of epileptogenesis." The authors suggest an aggressive therapeutic approach to managing patients with encephalitis-associated SE in order to reduce the risk of complications. In contrast, they say that SE caused by low AED levels should be treated more conservatively. They say, "?insufficient levels of AEDs in patients with pre-existing epilepsy were not seen at all in the RSE group, but this was the most common cause of NRSE?With respect to therapeutic management in clinical practice, treatment escalation in SE caused by insufficient levels of AEDs should be used reluctantly." Reference...