Refractory status epilepticus: a prospective observational study

Epilepsia. 2010 Feb;51(2):251-6. doi: 10.1111/j.1528-1167.2009.02323.x. Epub 2009 Oct 8.


Purpose: Status epilepticus (SE) that is resistant to two antiepileptic compounds is defined as refractory status epilepticus (RSE). In the few available retrospective studies, estimated RSE frequency is between 31% and 43% of patients presenting an SE episode; almost all seem to require a coma induction for treatment. We prospectively assessed RSE frequency, clinical predictors, and outcome in a tertiary clinical setting.

Methods: Over 2 years we collected 128 consecutive SE episodes (118 patients) in adults. Clinical data and their relationship to outcome (mortality and return to baseline clinical conditions) were analyzed.

Results: Twenty-nine of 128 SE episodes (22.6%) were refractory to first- and second-line antiepileptic treatments. Severity of consciousness impairment and de novo episodes were independent predictors of RSE. RSE showed a worse outcome than non-RSE (39% vs. 11% for mortality; 21% vs. 63% for return to baseline clinical conditions). Only 12 patients with RSE (41%) required coma induction for treatment.

Discussion: This prospective study identifies clinical factors predicting the onset of SE refractoriness. RSE appears to be less frequent than previously reported in retrospective studies; furthermore, most RSE episodes were treated outside the intensive care unit (ICU). Nonetheless, we confirm that RSE is characterized by high mortality and morbidity.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticonvulsants / therapeutic use*
  • Comorbidity
  • Consciousness Disorders / diagnosis
  • Consciousness Disorders / epidemiology
  • Drug Resistance
  • Female
  • Humans
  • Intensive Care Units
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prevalence
  • Probability
  • Prognosis
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / epidemiology
  • Status Epilepticus / mortality


  • Anticonvulsants