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Status epilepticus associated with acute encephalitis: long-term follow-up of functional and cognitive outcomes in 72 patients

W Chen, Y Su, M Jiang, G Liu, F Tian, G Ren
European Journal of Neurology 2018, 25 (10): 1228-1234

BACKGROUND AND PURPOSE: Continued care in patients with encephalitis and prolonged status epilepticus (SE) is controversial. Limited data are available on the functional and cognitive outcomes.

METHODS: In a prospective cohort study from 2007 to 2016, patients with acute encephalitis and SE were reviewed. Long-term outcomes including motor disability (modified Rankin Scale, mRS), daily living skills (activities of daily living, ADL), cognitive ability (modified Telephone Interview for Cognitive Status, TICS-M) and epilepsy sequelae were evaluated in survivors at the 12-month follow-up.

RESULTS: At the 12-month follow-up, 72 patients were recruited who got a median score of 14 on the total ADL. 68% patients remained independent in their daily activities (mRS ≤ 2). Post-SE symptomatic epilepsy was observed in 49% of patients. Sixty-two patients achieved a median score of 40 on the TICS-M and 14 on the TICS-M Memory. Patients with autoimmune encephalitis were less prone to post-SE symptomatic epilepsy (18% vs. 58%, P = 0.005) but had lower TICS-M Memory score than those with viral encephalitis (8.5 vs. 15, P = 0.017). Compared to non-refractory status epilepticus (non-RSE), patients with RSE had a longer stay in the neurocritical care unit (39 vs. 26, P = 0.002), more in-hospital complications and post-SE symptomatic epilepsy (67% vs. 33%, P = 0.005). Long-term outcomes including ADL, mRS and TICS-M were not significantly different between patients with RSE and non-RSE or between patients with long (≥4 h) and short (<4 h) duration of SE.

CONCLUSIONS: Survival with favorable functional recovery was promising after prolonged RSE in patients with acute encephalitis.


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