Authors :
Presenting Author: Fawad Khan, MD – Ochsner Neuroscience Institute, Ochsner Health
Anil Chimakurthy, MD – Decatur Morgan Hospital
Margaret Gopaul, PhD, MSCP – Yale University | VA-Connecticut Healthcare System
Samuel Carter, DO – Ochsner Neurosciences Institute, Ochsner Health
Rationale:
While the diagnosis of status epilepticus (SE) is clearly defined using clinical and electroencephalographic (EEG) criteria—enabling standardization in both retrospective and prospective treatment trials—there is far less clarity around the definition of treatment success. In particular, there is no universal guidance on how EEG should be used to determine the successful resolution of SE, including refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). Despite EEG being central to diagnosing SE, its role in determining clinical endpoints remains inconsistent. To address this gap, we conducted a scoping review examining how EEG has been used in published clinical studies to evaluate treatment success in SE.
Methods:
We conducted a systematic search of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Our review included peer-reviewed studies published in English between January 1, 1980, and July 1, 2024, that evaluated the effectiveness of treatment interventions in SE, RSE, and SRSE. Data were extracted on study population, study design (retrospective or prospective), interventional therapies used, diagnostic criteria applied for SE, and the methodologies employed to define SE resolution—particularly with regard to whether and how EEG was used to assess treatment success.
Results:
EEG-based definitions of treatment success varied widely. Burst suppression was required in 3 studies, while suppression of all epileptiform activity, absence of lateralized or generalized periodic discharges, and stable non-evolving EEG patterns post-weaning were each reported in only one study. A few studies included relapse criteria, such as no recurrence within 30–60 minutes (4 studies) or no relapse over 12–24 hours (2 studies). Notably, 31 studies provided no methodological details on how EEG was used to determine or confirm the endpoint of status epilepticus following treatment.
Conclusions:
In our analysis of studies over the past four decades, numerous trials have evaluated treatment efficacy in SE. However, only a minority used EEG to define the treatment endpoint for SE, RSE, or SRSE. Among those that did, EEG criteria were inconsistently reported, highly variable, and lacked standardization. This heterogeneity hinders meaningful comparison across studies and limits insights into treatment effectiveness, especially for novel therapies. A standardized framework for EEG-based SE endpoint definitions is urgently needed to enhance trial comparability, support clinical decision-making, and improve patient outcomes.
Funding: None