Clinician-Reported Physical and Cognitive Impairments After Convulsive Status Epilepticus: Post Hoc Study of a Randomized Controlled Trial

• Published in: Neurocritical care 2024-04, Vol.40 (2), p.495-505
• Main Authors: Jacq, Gwenaëlle, Crepon, Benoit, Resche-Rigon, Matthieu, Schenck, Maleka, Geeraerts, Thomas, Meziani, Ferhat, Megarbane, Bruno, Chaffaut, Cendrine, Cariou, Alain, Legriel, Stephane
• Format: Article
• Language: English
• Subjects: Brain; Clinical trials; Cognition & reasoning; Cognitive Dysfunction - etiology; Cognitive Dysfunction - therapy; Comorbidity; Convulsions & seizures; Critical Care Medicine; Epilepsy; Guillain-Barre syndrome; Humans; Hypothermia; Hypothermia, Induced; Intensive; Intensive care; Internal Medicine; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; NCT; NCT01359332; Neurology; Neurosurgery; Original Work; Patients; Status Epilepticus; Stroke; Treatment Outcome; Ventilators
• ISSN: 1541-6933; 1556-0961; 1556-0961
• DOI: 10.1007/s12028-023-01758-6

Background Clinician-reported outcome (ClinRO) measures are emerging as useful contributors to assessments of treatment benefits. The objective of this study was to collect ClinRO measures of physical and cognitive impairments after convulsive status epilepticus (CSE) requiring intensive care unit admission. Methods We conducted a post hoc analysis of the data from HYBERNATUS, a multicenter open-label controlled trial that randomized 270 critically ill patients with CSE requiring mechanical ventilation in 11 French intensive care units to therapeutic hypothermia (32–34 °C for 24 h) plus standard care or standard care alone. We included all patients who attended a day 90 in-person neurologist visit with measurement of the functional independence measure (FIM) score (range from 18 [total assistance] to 126 [total independence]), Mini-Mental State Examination (MMSE) score (range 0–30), and Glasgow outcome scale (GOS) score (1, death; 2, vegetative state; 3, severe disability; 4, moderate disability; and 5, mild or no disability). These three scores were compared across groups defined by several patient and CSE characteristics. Results Of 229 patients with GOS scores ≥ 3 on day 90 (male sex, 58.2%; median age, 56 years [47–67]), 67 (29%) attended an in-person neurologist visit. Twenty-nine (43%) patients had a previous history of epilepsy, and 16 (24%) patients had a primary brain insult. CSE was refractory in 22 (33%) patients. On day 90 after CSE onset, median FIM and MMSE scores were 121 (112–125) and 26.0 (24.0–28.8), respectively. The GOS score was 3 in 16 (33.8%) patients, 4 in 9 (13.4%) patients, and 5 in 42 (62.7%) patients. Worse GOS score values were significantly associated with worse FIM and MMSE scores. Conclusions In patients attending the in-person neurologist visit on day 90 after CSE onset, ClinRO measures indicated that the main impairments were cognitive. FIM and MMSE scores were associated with GOS scores. Further studies are needed to evaluate the possible impact of neuroprotective and rehabilitation strategies on disability and cognitive impairments in survivors of CSE. Clinical trial registration NCT01359332.