Abstracts

Rationale: Although Nonconvulsive Status Epilepticus (NCSE) is associated with significant morbidity and mortality, there are limited guidelines regarding treatment and prognosis. Many patients with NCSE benefit from aggressive antiepileptic drug (AED) treatment. Despite the most aggressive therapies, however, not all patients recover fully. Acute clinical and EEG responses to intravenous (IV) benzodiazepine (BDZ) administration were assessed for their utility to predict subsequent outcome and guide therapy in patients with suspected NCSE. Methods: All patients referred to the inpatient service with suspected NCSE and tested with an acute IV BDZ protocol were included. Clinical and EEG responses to this initial BDZ test were correlated with subsequent outcomes. Results: 62 patients with suspected NCSE who received test doses of IV BDZ were identified. Immediately after BDZ administration, clinical and EEG responses were assessed. 22 (35%) had a clinical response of substantial improvement in level of consciousness, whereas 40 (65%) were clinical non responders. Of the clinical non responders, 14 (35%) recovered consciousness, 22 (55%) survived, and 59% of the survivors had poor functional outcomes. In contrast, all (100%) of the clinical responders survived, recovered consciousness, and had good functional outcomes (p<.001). EEG improvement was also a predictor of subsequent recovery of consciousness and functional outcome (p<.05), but not of survival. Conclusions: This study demonstrates that a favorable clinical response to an IV dose of BDZ in patients with suspected NCSE predicts recovery of consciousness during hospitalization, survival at hospital discharge, and good functional outcome. These findings help stratify patients with NCSE who would benefit most from aggressive antiepileptic drug therapy and may guide management. Study supported by Rosen Foundation for Clinical Neurological Research.