Diagnostics and Non-pharmacological interventions for refractory and super refractory status epilepticus in Germany: A comprehensive analysis of 4 years of billing data

Background

Status epilepticus (SE) is a critical neurological emergency, with its most severe form, refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE), posing significant treatment challenges and high mortality rates. Despite robust early-phase treatment evidence, effective management of RSE and SRSE remains less defined.

Objective

This study aimed to assess the incidence of potential RSE and SRSE in Germany from 2019 to 2022, evaluate diagnostic and non-pharmacological interventions, and analyze associated healthcare costs.

Methods

A cross-sectional retrospective analysis was conducted using data from the Institute for the Hospital Remuneration System (InEK). Cases were identified using ICD-10 code G41 and included patients who underwent mechanical ventilation for at least one hour. Data on demographics, diagnostic procedures, therapeutic interventions, discharge outcomes, and healthcare costs were extracted and analyzed.

Results

Between 2019 and 2022, 89,921 SE cases were identified, with 21,729 (24.2 %) progressing to potential RSE or SRSE. Male patients comprised 56 % of these cases. The majority of cases occurred in patients aged 65–74 years. The overall mortality or hospice transfer rate for potential RSE/SRSE cases was 33.7 %. Common diagnostic procedures included EEG (80 %) and CT scans (113 %), while non-pharmacological interventions such as hypothermia therapy were used in 10 % of cases, and plasmapheresis was employed in 1 %. Electroconvulsive therapy, vagus nerve stimulation, deep brain stimulation, transcranial magnetic stimulation, ketogenic diet, resection of foreign tissue from the brain, and epilepsy surgery were not performed at all. 4 % of the patients who died in the hospital or were discharged to a hospice received interventions in a palliative care setting. The total estimated cost for potential RSE/SRSE cases in 2022 was approximately €44.24 million, highlighting the economic burden on the healthcare system.

Conclusion

The study underscores the need for improved diagnostic and therapeutic strategies in managing RSE and SRSE. It also calls for exploration of non-pharmacological treatments to reduce the high mortality and economic costs associated with these conditions. Further research is essential to establish evidence-based protocols for RSE and SRSE management.