Hospitalization for status epilepticus is associated with increased morbidity, mortality and costs, and the outcomes are worse with increasing disease refractoriness, according to study results published in JAMA Neurology.

Previous studies have shown that patients with status epilepticus frequently require treatment with multiple drugs in an intensive care unit, associated with worse clinical outcomes and higher costs. However, limited data exist on the association between disease refractoriness with clinical outcomes and costs.

This cross-sectional study included 43,988 hospitalizations for status epilepticus from January 1, 2016 to December 31, 2018. Of these, 14,694 admissions (33.4%) were for low refractory, denoted as treatment with no more than 1 intravenous antiseizure drug, 10,140 (23.1%) were for moderate refractory, denoted as treatment with more than 1 intravenous antiseizure drug, and 19,154 admissions (43.5%) were for highly refractory status epilepticus, denoted as at least 1 intravenous antiseizure drug, at least 1 third-line intravenous anesthetic, and intensive care unit admission.

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The study outcomes included discharge disposition, length hospital stay length of stay in intensive care unit, hospital-acquired conditions, and total and per diem costs.

As 4939 died during the hospitalization, the overall in-hospital mortality rate was 11.2%. The highest in-hospital mortality rate was reported for patients with highly refractory status epilepticus (18.9%), followed by those with moderate (6.3%) and low (4.6%) refractory status epilepticus (P <.001 for all comparisons).

Overall, median hospital length of stay was 5 days, with increased length of stay with more refractory disease: 3 days for patients with low, 4 days for patients with moderate, and 8 days for patients with highly refractory status epilepticus (P <.001 for all comparisons).

Median total hospital cost was 13,201 USD, with greater costs in patients with highly refractory status epilepticus (median, 25,105 USD) compared with low (median, 6812 USD) and moderate (median, 10,592 USD) refractory status epilepticus.  Median per diem cost was 2806 USD.

The study had several limitations, including lack of long-term outcome data, potential misclassification through the use of ICD coding and denoting refractoriness according to the number and type of antiseizure drugs, and exclusion of patients who were transferred to or from another acute hospital.

“Interventions that prevent SE [status epilepticus] from progressing to a more refractory state may have the potential to improve outcomes and lower costs associated with this neurologic condition,” concluded the study researchers.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Guterman EL, Betjemann JP, Aimetti A, et al. Association between treatment progression, disease refractoriness, and burden of illness among hospitalized patients with status epilepticus. JAMA Neurol. Published online April 5, 2021. doi:10.1001/jamaneurol.2021.0520