Prognosis

In-hospital mortality and predictors

Overall mortality associated with SE approaches 20%.[9][20][33] One study of pediatric SE reported in-hospital mortality at about 3%.[81] A similar case-fatality rate of 3.45% was reported in a large nationwide cohort that included patients of all ages.[82] In that study, predictors of mortality included older age, higher comorbidity index, use of mechanical ventilation, and hypoxic brain injury. Despite changes in management, epidemiologic studies have not shown a marked change in SE-related mortality rates in high-income countries over the past decades, although reported rates are variable across studies.[8][83]

Numerous studies have found that acute symptomatic etiology (e.g., stroke or post-anoxic injuries) and longer duration of SE predict a poorer prognosis.[10][20] Alcohol-related or poor compliance-related SE carries a more favorable outcome than SE of other causes, but recovery of these patients is usually marked by a prolonged postictal state.[11][84]

Super-refractory SE (SRSE) is defined as SE that continues or recurs 24 hours or more after the onset of anesthetic therapy or recurs on the reduction/withdrawal of anesthesia.[56]​[57]​ One systematic review and meta-analysis showed the outcome of SRSE is poor with a reported in-hospital mortality of 24.1%.[57]​ Only around one quarter of patients had an modified Rankin Scale (mRS) of 2 or less (2=slight disability, unable to perform all previous activities but able to look after own affairs without assistance; 1=no significant disability despite symptoms, able to carry out all usual duties and activities; 0=no symptoms) and less than 10% were completely independent at discharge.[57]​

Long-term follow-up

Long-term outcomes of SE vary significantly according to the underlying etiology, duration of seizures, age, sex, medical comorbidities, incidence of in-hospital complications, and treatment location.[85] One study reported that 7 of 8 survivors of refractory SE (treated with a standardized protocol of pentobarbital coma) remained stable for a mean 2.9 years following hospital discharge.[86] A subsequent report noted a 1-year recurrence rate of 17% for pediatric SE.[81] Patients recovering from SE often continue to have neurologic deficits, especially in memory and other cognitive areas.[85] This is likely secondary to excitotoxic injury of one or both hippocampi.[87]

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