Madzar D, et al. - Researchers performed this study to establish variables associated with super-refractory status epilepticus (SRSE) development and outcome. Better premorbid functional status and non-convulsive status epilepticus (NCSE) in coma as worst seizure type demonstrated a role of acute underlying etiologies in the development of SRSE. While the functional outcome in survivors depended on seizure duration, in-hospital mortality in SRSE was determined by nonmodifiable factors, emphasizing the need for achieving rapid seizure termination.

• Between January 2001 and January 2015, the researchers retrospectively screened their databases for refractory SE (RSE) and SRSE episodes.
• They compared baseline demographics, SE characteristics, and variables reflecting the clinical course to identify factors independently associated with SRSE occurrence.
• Through univariate and multivariable analyses, predictors of in-hospital mortality as well as good functional outcome in survivors to discharge were established within the SRSE cohort.

• Among those 46 (35.1%) meeting the criteria of SRSE, 131 episodes were included.
• Comparison of RSE and SRSE episodes demonstrated a lower premorbid mRS score (odds ratio (OR) per mRS point, 0.769; p = 0.039) and non-convulsive SE (NCSE) in coma (OR, 4.216; p = 0.008) as independent predictors of SRSE.
• In this study, SRSE in-hospital mortality was correlated with age (OR, 1.091 per increasing year; p = 0.020) and worse premorbid functional status (OR, 1.938 per mRS point; p = 0.044).
• In survivors, good functional outcome was independently associated with shorter SRSE duration (OR, 0.714 per day; p = 0.038).