PURPOSE: Super refractory status epilepticus (SRSE) is an uncommon, but important clinical problem with high morbidity and mortality. Studies concerning SRSE has been limited and there are no existing Philippine data. The study aims to determine the status of Refractory (RSE) and SRSE within a 10-year period in a Tertiary Hospital. METHODS: This is a retrospective study of adult patients with prolonged seizures admitted at The Medical City, Philippines from January 2009- July 2018. Multinomial Logistic Regression was used to assess probability of good or poor outcome. Significant Correlation is defined by P value of <0.05. RESULTS: The Incidence of RSE is as high as 38% (n=64) and 35% (n=58) for SRSE. Mortality rate is 39.1% in RSE and 62.1% in SRSE. Poor functional outcome is observed in RSE and SRSE wherein the majority was Alive Dependent. Significant factor increasing likelihood of being Alive Dependent is the absence of Arrest. CONCLUSION Factors associated with likelihood of being alive and independent includes Status Epilepticus and younger age therefore aggressive seizure control to prevent progression to SRSE will give higher likelihood of good functional outcome and elderly patients warrant closer and more adept seizure control for better functional outcome.
Status Epilepticus ; Philippines ; Seizures

BACKGROUND: Neurologic outcomes following a cardiac arrest is reported to be detrimental and survivors face significant neurologic disability attributed to the diffuse cerebral damage from anoxia. Accurate prognostication is challenging. OBJECTIVE: To determine the prognosis of patients who had seizures after arrest. METHODS: This is an analytic, retrospective cohort study of adult patients that had successful resuscitation after cardiac arrest. The final sample size was 97. Comparison of the clinical outcomes was done using univariate and multivariate analysis. Multiple logistic regression was utilized. Level of significance was set at α-0.05. RESULTS: Post-arrest seizures increased the odds of dying up to 9 times. Age increases the odds of dying; among patients aged 65 years old and above, the odds are increased to 17 times, while among those aged 35 years old and above, the odds are up to 12 times. Presence of an intact brainstem response in the first 72 hours after arrest have 96% lower odds of dying compared to those who have none. CONCLUSION Patients with post-arrest seizures have higher morbidity and mortality rates. Patients with seizures that occur early after cardiac arrest have poorer prognosis and higher chances of death brought about by additional insults to an already damaged brain. Older patients have poorer prognosis. Preserved brainstem function seem to be a protective factor which can be a reflection of the degree of preserved brain activity despite anoxia.
Prognosis

Background: Alpha coma and its variants theta coma and alpha-theta coma (ATC) are clinical coma states characterized by electroencephalographic patterns resembling those of wakefulness. The complete (unreactive) form of these states is invariably associated with poor outcomes among post-anoxic comatose patients.Case Report: Herein, we present three adult comatose patients (aged 21, 45, and 51 years) with unreactive ATC patterns, who exhibited remarkable neurological improvement. Two patients experienced post-cardiopulmonary arrest (due to electrocution and viral myocarditis, respectively), while the third had severe septic encephalopathy. Electroencephalograms (EEGs) taken at least 24 hours after coma onset revealed unreactive ATC patterns. All patients survived, achieving significant neurological improvement. Remarkably, in one patient, the only symptom was minor incoordination during ambulation upon discharge. Conclusion These cases challenge the grave prognosis associated with this EEG pattern, particularly in post-anoxic comatose patients. Factors such as younger age, presence of shockable rhythms, and cause of arrest may have contributed to these favorable outcomes.

Background: Alpha coma and its variants theta coma and alpha-theta coma (ATC) are clinical coma states characterized by electroencephalographic patterns resembling those of wakefulness. The complete (unreactive) form of these states is invariably associated with poor outcomes among post-anoxic comatose patients.Case Report: Herein, we present three adult comatose patients (aged 21, 45, and 51 years) with unreactive ATC patterns, who exhibited remarkable neurological improvement. Two patients experienced post-cardiopulmonary arrest (due to electrocution and viral myocarditis, respectively), while the third had severe septic encephalopathy. Electroencephalograms (EEGs) taken at least 24 hours after coma onset revealed unreactive ATC patterns. All patients survived, achieving significant neurological improvement. Remarkably, in one patient, the only symptom was minor incoordination during ambulation upon discharge. Conclusion These cases challenge the grave prognosis associated with this EEG pattern, particularly in post-anoxic comatose patients. Factors such as younger age, presence of shockable rhythms, and cause of arrest may have contributed to these favorable outcomes.

Background: Alpha coma and its variants theta coma and alpha-theta coma (ATC) are clinical coma states characterized by electroencephalographic patterns resembling those of wakefulness. The complete (unreactive) form of these states is invariably associated with poor outcomes among post-anoxic comatose patients.Case Report: Herein, we present three adult comatose patients (aged 21, 45, and 51 years) with unreactive ATC patterns, who exhibited remarkable neurological improvement. Two patients experienced post-cardiopulmonary arrest (due to electrocution and viral myocarditis, respectively), while the third had severe septic encephalopathy. Electroencephalograms (EEGs) taken at least 24 hours after coma onset revealed unreactive ATC patterns. All patients survived, achieving significant neurological improvement. Remarkably, in one patient, the only symptom was minor incoordination during ambulation upon discharge. Conclusion These cases challenge the grave prognosis associated with this EEG pattern, particularly in post-anoxic comatose patients. Factors such as younger age, presence of shockable rhythms, and cause of arrest may have contributed to these favorable outcomes.

Introduction: The increasing incidence of stroke in young adults has been a growing concern, which is why research studies were generated to find out the risk factors contributing to the development of this disease. This study investigated the dose-dependent effect of smoking in the development of stroke in the young ages (19-45 years). Methods: A case-control retrospective study was conducted using electronic and printed records of the patients admitted to Amang Rodriguez Memorial Medical Center last 2017-2018. There were 275 patients included in the study. The smoking status and pack-years cigarette smoking of the subjects were recorded and were correlated with the duration of hospitalization and the Modified Rankin Scale (MRS). Results were analyzed using student’s t-test, ANOVA, and Pearson’s Correlation. Result: The prevalence of stroke was higher in men than in women. The ORs (95% CI) of stroke were significant in current cigarette smoking at 2.71 (CI: 1.6398 to 4.4943). Compared with non-smokers and those who smoked 1 to 9 pack years, the OR of stroke was significantly increased for those who smoked 10 to 19, and ≥ 20 cigarettes per day with OR of 14.0765 (4.10 to 48.35), and 31.5854 (1.82 to 548.97), respectively (p= 0.032 for linear trends). There was a weak positive linear correlation between pack years of cigarette smoking (1-9, 10-19, >20 pack years) and days of hospitalization (r= 0.28; p for trend = 0.0168). There was also a strong positive linear correlation between stroke outcome using the Modified Rankin Scale and pack years of cigarette smoking (r = 0.72; P for trend = 0.001). This study shows an increase in the odds of stroke in current cigarette smokers with a dose-dependent relationship in its outcome. Conclusion Smoking is a significant risk factor for stroke with a dose-dependent effect on its outcome. Furthermore, quitting smoking significantly decreases the risk of developing stroke.
Stroke ; Case-Control ; Retrospective