Explore the ethical considerations and challenges in neurosurgery through our latest blog post on “Long-term outcome in new onset refractory status epilepticus: a retrospective study,” shedding light on the complexities of treatment decisions and patient care.
– by James
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Long-term outcome in new onset refractory status epilepticus: a retrospective study.
Stretti et al., Crit Care 2024
<!– DOI: 10.1186/s13054-024-04858-7 //–>
https://doi.org/10.1186/s13054-024-04858-7
This retrospective study, conducted at the University Hospital Zurich, Switzerland, focused on 25 patients with New Onset Refractory Status Epilepticus (NORSE) out of 283 adults admitted for status epilepticus between January 2010 and December 2022. The study aimed to explore ICU treatments, outcomes, and ethical decisions surrounding these patients. Key findings include:
– The majority of NORSE patients were female (68%), relatively young (average age 54), and previously healthy.
– A significant 96% experienced super-refractory status epilepticus, with 68% of cases remaining cryptogenic despite extensive evaluations.
– In-hospital mortality was 36%, increasing to 56% at the last follow-up (average 30 months post-ICU admission). Most in-hospital deaths (89%) resulted from the withdrawal or withholding of therapies, typically decided by medical staff 29 days after ICU admission.
– For survivors, the functional outcome significantly improved over time, with 81% showing better scores at the last follow-up compared to hospital discharge.
Importance: This study underscores the potential for favorable long-term outcomes in NORSE survivors, despite initial severe presentations and complex ICU stays. It highlights the critical need for cautious end-of-life decision-making to avoid premature cessation of treatment, suggesting a more optimistic approach may be warranted in managing NORSE cases.