Status epilepticus (SE) is a neurological emergency characterized by failure of seizure-terminating mechanisms, leading to prolonged epileptic activity and a high risk of lasting neuronal damage. Rapid diagnosis and treatment are crucial, yet prognostication remains complex and influenced by multiple clinical and electrophysiological factors. This thesis examines determinants of outcome in critically ill patients with SE through five studies performed in tertiary Swiss intensive care units (ICUs), with a focus on EEG-based diagnosis, treatment strategies, and prognostic indicators.
The implementation of a dedicated ICU-EEG service significantly increased the detection of nonconvulsive SE (NCSE), reduced treatment delays, and improved neurological outcomes, demonstrating the organizational impact on clinical care. From a biochemical perspective, hypoalbuminemia emerged as an independent predictor of mortality and functional disability, and its integration into established prognostic scores improved their predictive performance.
Therapeutic analysis revealed that early initiation of anesthetic coma, when first-line anticonvulsants fail, is safe and contributes to quicker seizure termination and shorter ICU stay, supporting a more proactive approach in selected patients. For postanoxic SE, pooled cohort data identified a subgroup without established markers of irreversible injury who achieved favorable outcomes when aggressive treatment was pursued, highlighting the critical role of multimodal neuroprognostication to prevent premature therapeutic limitations.
Finally, a systematic review emphasized the inconsistency in terminology and classification of post-cardiac arrest myoclonus, underlining the necessity for standardized definitions to guide diagnosis and treatment decisions.
Overall, the results of this thesis support a personalized, EEG-centered approach to SE management. Improving access to continuous EEG, refining prognostic tools with clinical and biomarker data, and optimizing treatment strategies may substantially influence recovery potential in this vulnerable population.
