The spectrum of cognitive outcomes following admission to hospital for refractory status epilepticus (RSE): A scoping review

Background

Refractory status epilepticus (RSE) may have many different causes. Preventing neurological complications and controlling acute seizures are early priorities, but long-term cognitive consequences must also be considered.

Objective

The objective of this scoping review is to report the spectrum of outcomes following admission to hospital for RSE from all etiologies and to determine whether there is evidence to suggest that survivors of new-onset RSE (NORSE) have different cognitive outcomes compared to survivors of RSE of identified etiology.

Methods

Scoping review methodology was used for this study. A clinical librarian prepared the search strategy. Studies were eligible if they were original research reporting cognitive outcomes after RSE.

Results

2202 articles were identified, of which 2121 were excluded. After full text review, we included 14 studies. Studies were from 2005–2023 and included retrospective, prospective and case studies with a total of 323 patients from ages 1–80 years. Outcomes were similar across studies, but there was heterogeneity with respect to tests used and timing of outcome measurement. Most pediatric reports were in survivors of NORSE and a minority of pediatric survivors return to baseline, with a large proportion of survivors having intellectual disability ranging from mild to severe. Outcomes were less consistent across adult survivors, with some having minimal cognitive impairment and others reporting that no previously employed patients returning to employment.

Conclusion

Current approaches to cognitive assessment in survivors of RSE are highly variable. A large proportion of survivors had impairment in greater than one cognitive domain. Future research should focus on using age-appropriate, domain-specific tools administered at defined timepoints post-RSE.