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There is general agreement among neurologists, emergency physicians, and intensivists that status epilepticus is a medical emergency; that the longer status goes on, the more difficult it is to stop; and that as the status moves up the severity spectrum from simple status to refractory status requiring treatment with an anesthetic to super-refractory status requiring more than 1 course of anesthetic treatment, the lower the likelihood of successful treatment and the higher the mortality.1 In this issue of JAMA Neurology, Hocker and colleagues2 present a retrospective study demonstrating the evolution of apparent brain atrophy in a series of adult patients treated at the Mayo Clinic with so-called super-refractory status epilepticus (SRSE). Patients with an overt anoxic ischemic etiology, epilepsia partialis continua, and absence of status were excluded. This series of 19 patients, culled from 42 who met the authors’ diagnostic criteria for SRSE, were selected for study based on the availability of magnetic resonance imaging (MRI) scans at prespecified points in time. The authors use a straightforward metric, percentage change in the ventricular brain ratio (ΔVBR), to quantify change in brain volume between 2 scans, one obtained within 2 weeks of onset of SRSE and the second within 6 months of resolution of SRSE but at least 1 week after the initial scan. The main findings stated by the authors are that in all patients studied, measurable brain atrophy developed between the 2 scans obtained, and amount of atrophy was positively correlated with duration of anesthetic therapy, negatively correlated with patient age, and not correlated with functional outcome. Curiously, no table of case-wise data are provided, making it difficult for readers to inspect the case-by-case association between degree of ΔVBR and duration, etiology, treatment, or even age of the specific patients.
Cole AJ. Status Epilepticus and Brain AtrophyShrinkage Is a Growing Problem. JAMA Neurol. 2016;73(10):1182-1183. doi:10.1001/jamaneurol.2016.2639