Predictive Factors for Refractory Convulsive Status Epilepticus: a 7-year Retrospective Study

Marc Laurence L. Fernandez, Leah L. Shiong Shu, Natasha L. Fabiana,
Paul Matthew D. Pasco, Leonor I. Cabral-Lim, and Josephine C. Gutierrez

Department of Neurosciences, College of Medicine,
Philippine General Hospital, University of the Philippines Manila

Background. Status epilepticus (SE) is defined as continuous seizure activity lasting for more than 30 minutes without full recovery of consciousness. Refactory convulsive status epilepticus (RCSE) is defined as convulsive seizures lasting more than 60 mintues despite treatment using first- and second-line intravenous anti-epileptic drugs (AEDs) and anesthetic agents.

Objectives. To determine the incidence of RCSE among patients with status epilepticus (SE) within a 7-year period in the Philippine General Hospital. Specifically, this study aims to identify risk factors associated with the progression of SE into RCSE.

Methods. This is a retrospective study of Filipino adults admitted at the Philippine General Hospital from January 2003 to September 2010 for SE.

Results. One hundred eight (108) patients were identified to have SE. Of these, only 66 had available hospital records. Among patients with SE, 16% (n=11) were identified to have RCSE. Only two variables were significantly associated with RCSE, namely, first-onset seizures (p=0.0214), and abnormal cranial imaging (p=0.131). Sensitivity of first onset seizures and abnormal cranial imaging as predictive factors for developing RCSE is 81.82%, and the specificity of the two variables is 52.7% and 63.4%, respectively. The presence of both factors predicts RCSE with a high sensitivity rate of 82%.

Conclusion. The incidence of RCSE among patients with SE is 16%. The significant risk factors for developing RCSE are abnormal cranial imaging and first-onset seizures. Presence of both variables can predict occurence of RCSE with a relatively high sensitiviy rate.

Key Words: status epilepticus, refractory convulsions, seizures