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Revista Ecuatoriana de Neurología
versión On-line ISSN 2631-2581versión impresa ISSN 1019-8113
Resumen
RIVERO-RODRIGUEZ, Dannys et al. Clinical And Outcome Analysis Of Patients With Refractory Status Epilepticus According To The Third-Line Treatment Scheme Used. Rev Ecuat Neurol [online]. 2023, vol.32, n.2, pp.61-66. ISSN 2631-2581. https://doi.org/10.46997/revecuatneurol32200061.
Introduction:
The evidence available in the treatment of refractory status epilepticus (RSE) is limited.
Objective:
Evaluate the clinical and outcome factors in patients with refractory status epilepticus (RSE) according the third line treatment used (midazolam-MDL and/or propofol-PRO).
Methods:
Retrospective cohort study included 34 patients treated by RSE during November 2015 to June 2018.
Variables:
Age, severity and etiology of RSE, pretreatment level of consciousness, anesthetic drugs (MDL-PRO), outcome at hospital discharge and 3 months according Rankin score.
Results:
Mean of age of the patients was 51.21±22.3 years and 32.4% (11) had previous history of epilepsy. Super RSE (SSRE) was diagnosed in 35.3% (12) of sample. Mortality reached up 50% of patients and extended to 55.9% at 3 months. Patients treated with MDL had higher rate of vasopressor needs (71.4% vs 50.0%) and the group who received a scheme of combined treatment MDL-PRO included mainly a SSRE patients (p≤0.01), higher rate of tracheostomy (p=0.03), vasopressor drugs (p=0.01) and diminished dosage of anesthetic drugs (p=0.05). Surveillance analysis according Kaplan Meier curve did not found significant differences at 3 months in survival rate between groups. MDL vs PRO (Log Rank=0. 17), MDL vs MDL-PRO (Log Rank=0. 49) y PRO vs MDL-PRO (Log Rank=0. 48).
Conclusion:
Patients with RSE had a high mortality, without evidence of increase of mortality in groups according anesthetic drugs used and schemed of treatment applied.
Palabras clave : Status epilepticus; Refractory status epilepticus; Midazolam; Propofol; Induced therapeutic coma..