Status epilepticus (SE) is a common neurological emergency and is associated with a poor functional prognosis. Almost 40% of patients have a patent functional impairment at three months [1], [2], [3]. Generalized convulsive SE (GCSE) is usually considered as the most severe type of SE [2]. The continuous epileptic activity is thought to induce diffuse neurological injuries and to be responsible for subsequent sequelae [1]. Outcome seems to be related to the duration of SE and several studies have shown that the interruption of SE is more difficult the longer it continues [4], [5]. In this regard, the management of SE has focused on early seizure termination in order to improve prognosis [1].

Refractory status epilepticus (RSE) is defined as a persistent epileptic seizure despite the use of first- and second-line anti-seizure medication (ASM) and may be an indication for using anesthetic drugs in patients with SE [6], [7]. However, up to 75% of patients are intubated rather for airway protection in postictal coma or respiratory failure [8]. According to the American Clinical Neurophysiology Society Consensus Statement, continuous electroencephalogram (cEEG) monitoring is recommended in patients with persistently abnormal mental status following GCSE, but in many hospitals cEEG monitoring is not easily available and little evidence is available to guide the management of sedation in such cases [9].

Thus, it is of particular interest to identify the patients prone to recurrent or persistent seizures to adapt their management. Aggressive treatment could be discussed for these patients in order to interrupt the epileptic activity. Furthermore, in resource-limited settings, such predictors could be used to decide how to choose patients who will benefit from closer cEEG monitoring [10]. On the other hand, patients with low risk for recurrent or persistent seizures could benefit from early and quick withdrawal of sedation considering the impact of inappropriate sedation on outcome. Indeed, it has been reported that a prolonged sedation is associated with prolonged mechanical ventilation, and increased the hospital length of stay in patients admitted for RSE [11].

Previous studies have investigated the risk factors of RSE [6], [12], [13]. However, the factors associated with recurrent or persistent seizures under sedation and their impact are poorly studied [14]. We aimed to determine the prevalence, the associated factors of uncontrolled SE, and its impact on three-month outcome in patients with GCSE requiring MV. We hypothesized that identifying patients at risk of recurrent or persistent seizures under sedation could be useful to guide their management and improve the prognosis.