We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Status Epilepticus and Brain Atrophy Shrinkage Is a Growing Problem ONLINE FIRST

Andrew J. Cole, MD1,2
[+] Author Affiliations
1Epilepsy Service, Massachusetts General Hospital, Boston
2Department of Neurology, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. Published online August 15, 2016. doi:10.1001/jamaneurol.2016.2639
Text Size: A A A
Published online


There is general agreement among neurologists, emergency physicians, and intensivists that status epilepticus is a medical emergency; that the longer status goes on, the more difficult it is to stop; and that as the status moves up the severity spectrum from simple status to refractory status requiring treatment with an anesthetic to super-refractory status requiring more than 1 course of anesthetic treatment, the lower the likelihood of successful treatment and the higher the mortality.1 In this issue of JAMA Neurology, Hocker and colleagues2 present a retrospective study demonstrating the evolution of apparent brain atrophy in a series of adult patients treated at the Mayo Clinic with so-called super-refractory status epilepticus (SRSE). Patients with an overt anoxic ischemic etiology, epilepsia partialis continua, and absence of status were excluded. This series of 19 patients, culled from 42 who met the authors’ diagnostic criteria for SRSE, were selected for study based on the availability of magnetic resonance imaging (MRI) scans at prespecified points in time. The authors use a straightforward metric, percentage change in the ventricular brain ratio (ΔVBR), to quantify change in brain volume between 2 scans, one obtained within 2 weeks of onset of SRSE and the second within 6 months of resolution of SRSE but at least 1 week after the initial scan. The main findings stated by the authors are that in all patients studied, measurable brain atrophy developed between the 2 scans obtained, and amount of atrophy was positively correlated with duration of anesthetic therapy, negatively correlated with patient age, and not correlated with functional outcome. Curiously, no table of case-wise data are provided, making it difficult for readers to inspect the case-by-case association between degree of ΔVBR and duration, etiology, treatment, or even age of the specific patients.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections