Therapeutic coma is an established escalation strategy for generalized convulsive status epilepticus, but evidence for benefit in non‑convulsive status epilepticus (NCSE) remains limited. The authors sought to determine whether use of therapeutic coma in NCSE is associated with treatment‑related medical complications, mortality, ICU resource use, and short‑term seizure control.
This investigation was a retrospective cohort study of patients with NCSE treated at a single tertiary hospital. Patients were classified according to whether they received therapeutic coma, operationalized as continuous intravenous and/or inhalational anesthetic administration administered for seizure control.
The analytic approach addressed confounding by indication using inverse probability of treatment weighting (IPTW) based on propensity scores. The study report provides effect estimates from IPTW‑adjusted analyses for predefined outcomes.
A total of 283 patients with NCSE were included in the cohort. Of these, 111 patients (39.2%) received therapeutic coma as defined above. No other patient‑level details beyond these counts are reported in the abstract.
The primary outcome was the occurrence of predefined clinically relevant in‑hospital medical complications. These complications included pneumonia, sepsis, cardiac arrhythmias, acute renal failure, renal replacement therapy, venous thromboembolism (VTE) and cardiopulmonary resuscitation (CPR).
Secondary outcomes included in‑hospital mortality, ICU length of stay, and successful termination of NCSE. The authors used IPTW based on propensity scores to mitigate confounding by indication and report odds ratios (OR), relative risks (RR), and regression coefficients (β) with 95% confidence intervals (CI) and p values for comparisons.
In IPTW‑adjusted analyses, receipt of therapeutic coma was associated with significantly higher odds of multiple in‑hospital complications:
The association between therapeutic coma and venous thromboembolism did not reach statistical significance: OR 3.04, 95% CI 0.97–9.51; p = 0.057.
These findings indicate a consistent pattern of increased infectious, cardiac, and renal complications among patients treated with therapeutic coma in this cohort.
Therapeutic coma was associated with increased in‑hospital mortality: RR 1.86, 95% CI 1.28–2.71; p = 0.001.
ICU length of stay was longer in patients who received therapeutic coma: regression coefficient β = 1.36, 95% CI 1.13–1.60; p < 0.001, indicating a substantial increase in ICU resource utilization after adjustment.
Regarding short‑term seizure control, successful termination of NCSE occurred less frequently in patients treated with therapeutic coma (70.3%) than in those not receiving therapeutic coma (84.3%); p = 0.005.
In this retrospective cohort of NCSE patients, use of therapeutic coma correlated with substantially higher rates of defined in‑hospital complications, longer ICU stays, and increased in‑hospital mortality. The treatment group did not demonstrate superior short‑term seizure termination; in fact, seizure termination was less frequent among patients treated with therapeutic coma.
These results suggest that the risks associated with escalation to continuous anesthetic‑based therapeutic coma in NCSE may be considerable and that expected benefits in short‑term seizure control were not observed in this dataset. The authors highlight the need to weigh potential harms against uncertain benefit when considering therapeutic coma for NCSE.
The study protocol was approved by the local Ethics Committee of the Technical University Dresden (BO‑EK‑385072021). The requirement for written informed consent was waived because the analysis used anonymized routine clinical data. The authors declared no relevant financial or non‑financial conflicts of interest.
Limitations inherent to the report include the retrospective single‑center design and potential residual confounding despite IPTW; the abstract does not provide detailed baseline characteristics or granular timing of complications relative to therapeutic coma onset. Additional study details and full methodological descriptions are present in the published article but are not reported in the abstract.
Among patients with NCSE in this tertiary hospital cohort, therapeutic coma was associated with higher rates of pneumonia, sepsis, cardiac arrhythmias, renal complications, greater ICU utilization, and increased in‑hospital mortality, without improved short‑term seizure termination. Clinicians should consider these associations and the limited evidence of benefit when escalating to continuous anesthetic therapy for NCSE and weigh risks carefully on an individual patient basis.