Survivors and nonsurvivors of very prolonged status epilepticus

Several studies have shown reliable predictive factors for outcome in status epilepticus (SE), especially etiology and presentation in coma. Duration of SE is predictive, but probably only in the first few hours, and there have been many reports of patients treated successfully for SE lasting many days or weeks. Nevertheless, there are many other patients with SE treated for prolonged periods without success, sometimes apparently futilely. We compared clinical features of 10 survivors of prolonged SE with those of a matched cohort treated for similarly prolonged episodes but unsuccessfully, looking for exceptions to known predictive factors. Multiple medical problems (i.e., etiologies) and coma on presentation were confirmed as predictors of a poor outcome. Analysis of individual exceptions to these predictors showed that age, overall background health, and family input on the value of prolonged treatment, on the one hand, and earlier epilepsy plus rapid and accurate diagnosis and treatment, on the other, contributed to results different from what would have been expected.