{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T01:51:03Z","timestamp":1784080263174,"version":"3.55.0"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Although in epilepsy patients the likelihood of becoming seizure\u2010free decreases substantially with each unsuccessful treatment, to our knowledge this has been poorly investigated in status epilepticus (SE). We aimed to evaluate the proportion of SE cessation and functional outcome after successive treatment steps.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a post hoc analysis of a prospective, observational, multicenter cohort (Sustained Effort Network for treatment of Status Epilepticus [SENSE]), in which 1049 incident adult SE episodes were prospectively recorded at nine European centers. We analyzed 996 SE episodes without coma induction before the third treatment step. Rates of SE cessation, mortality (in ongoing SE or after SE control), and favorable functional outcome (assessed with modified Rankin scale) were evaluated after each step.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SE was treated successfully in 838 patients (84.1%), 147 (14.8%) had a fatal outcome (36% of them died while still in SE), and 11 patients were transferred to palliative care while still in SE. Patients were treated with a median of three treatment steps (range 1\u201313), with 540 (54.2%) receiving more than two steps (refractory SE [RSE]) and 95 (9.5%) more than five steps. SE was controlled after the first two steps in 45%, with an additional 21% treated after the third, and 14% after the fourth step. Likelihood of SE cessation (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.003), and reaching good functional outcome (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) decreased significantly between the first two treatment lines and the third, especially in patients not experiencing generalized convulsive SE, but remained relatively stable afterwards.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>The significant worsening of SE prognosis after the second step clinically supports the concept of RSE. However, and differing from findings in human epilepsy, RSE remains treatable in about one third of patients, even after several failed treatment steps. Clinical judgment remains essential to determine the aggressiveness and duration of SE treatment, and to avoid premature treatment cessation in patients with SE.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17817","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T01:54:26Z","timestamp":1698890066000},"page":"338-349","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Staged treatment response in status epilepticus: Lessons from the <scp>SENSE<\/scp> registry"],"prefix":"10.1111","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9300-4443","authenticated-orcid":false,"given":"Isabelle","family":"Beuchat","sequence":"first","affiliation":[{"name":"Department of Neurology Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne  Lausanne 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Osnabr\u00fcck  Osnabr\u00fcck Germany"},{"name":"Epilepsy Center M\u00fcnster\u2010Osnabr\u00fcck, Campus Osnabr\u00fcck  Osnabr\u00fcck Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-622X","authenticated-orcid":false,"given":"Stephan","family":"R\u00fcegg","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Basel, and University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Tilz","sequence":"additional","affiliation":[{"name":"Department of Neurology Krankenhaus Barmherzige Br\u00fcder  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5950-2692","authenticated-orcid":false,"given":"Eugen","family":"Trinka","sequence":"additional","affiliation":[{"name":"Department of Neurology Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Member of the European Reference Network EpiCARE  Salzburg Austria"},{"name":"Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience  Salzburg Austria"},{"name":"Department of Public Health Health Services Research and Health Technology Assessment, UMIT \u2013 University for Health Sciences, Medical Informatics and Technology  Hall in Tirol Austria"},{"name":"Karl Landsteiner Institute for Neurorehabilitation and Space Neurology  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6408-5777","authenticated-orcid":false,"given":"Iris","family":"Unterberger","sequence":"additional","affiliation":[{"name":"Department of Neurology Innsbruck Medical University  Innsbruck 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