This study aimed to evaluate the short-term and long-term functional outcomes of patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) across specific etiologies.

RSE and SRSE are associated with high morbidity and mortality, with etiology being the most critical determining factor.

Retrospective study of patients aged over 18 years with RSE and SRSE. Demographics, etiology, Modified Rankin Scale (mRS) at 0, 3-, 6-, 12-, and 24 months after discharge were assessed. Chi-Square tests and Kaplan-Meier curve were used for analysis.

A total of 457 patients were categorized by etiology: 206 (45.1%) structural lesion, 108 (23.6%) metabolic derangement, 65 (14.2%) hypoxic ischemic encephalopathy due to postcardiac arrest, 37 (8.1%) central nervous system (CNS) infection, 14 (3.1%) subtherapeutic antiseizure medication (ASM) levels, 13 (2.8%) autoimmune encephalitis, 12 (2.6%) unknown etiology, and 2 (0.4%) genetic diseases. The mortality rate at discharge was highest in postcardiac arrest group (83.1%), followed by CNS infection group (56.8%), and metabolic derangement group (45.4%), p<0.001. Structural group had significantly higher percentage of patients with bed-bound status at discharge (33.5%, p<0.001). Patients in subtherapeutic ASM levels group demonstrated the highest rate of functional independent at discharge (43.8%, p<0.001). For long-term outcome, we tracked the progression of mRS scores of patients in each etiology up to 24 months. The majority of patients (83.1%) in postcardiac arrest group experienced in-hospital mortality. The percentage of survivors had stabilized for all etiologies by the third month post-discharge. 

This large cohort study evaluated the outcomes of RSE and SRSE across specific etiologies up to 24 months post-discharge. RSE and SRSE due to postcardiac arrest had the poorest short-term outcomes (mRS 6). By the third month, the percentage of survivors had stabilized for all etiologies.