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Fong MWK, Stephens E, Brockington A, Jayabal J, Scott S, Zhang T, Litchfield R, Beilharz E, Dalziel SR, Jones P, Yates K, Thornton V, Bergin PS. Status epilepticus in Auckland, New Zealand: Treatment patterns and determinants of outcome in a prospective population-based cohort. Epilepsia 2024; 65:1605-1619. [PMID: 38634858 DOI: 10.1111/epi.17975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Determination of the real-world performance of a health care system in the treatment of status epilepticus (SE). METHODS Prospective, multicenter population-based study of SE in Auckland, New Zealand (NZ) over 1 year, with data recorded in the EpiNet database. Focus on treatment patterns and determinants of SE duration and 30-day mortality. The incidence, etiology, ethnic discrepancies, and seizure characteristics of this cohort have been published previously. RESULTS A total of 365 patients were included in this treatment cohort; 326 patients (89.3%) were brought to hospital because of SE, whereas 39 patients (10.7%) developed SE during a hospital admission for another reason. Overall, 190 (52.1%) had a known history of epilepsy and 254 (70.0%) presented with SE with prominent motor activity. The mean Status Epilepticus Severity Score (STESS) was 2.15 and the mean SE duration of all patients was 44 min. SE self-terminated without any treatment in 84 patients (22.7%). Earlier administration of appropriately dosed benzodiazepine in the pre-hospital setting was a major determinant of SE duration. Univariate analysis demonstrated that mortality was significantly higher in older patients, patients with longer durations of SE, higher STESS, and patients who developed SE in hospital, but these did not maintain significance with multivariate analysis. There was no difference in the performance of the health care system in the treatment of SE across ethnic groups. SIGNIFICANCE When SE was defined as 10 continuous minutes of seizure, overall mortality was lower than expected and many patients had self-limited presentations for which no treatment was required. Although there were disparities in the incidence of SE across ethnic groups there was no difference in treatment or outcome. The finding highlights the benefit of a health care system designed to deliver universal health care.
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Affiliation(s)
- Michael W K Fong
- Westmead Comprehensive Epilepsy Centre, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eleanor Stephens
- Westmead Comprehensive Epilepsy Centre, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Alice Brockington
- Auckland District Health Board, Grafton, Auckland, New Zealand
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jayaganth Jayabal
- Auckland District Health Board, Grafton, Auckland, New Zealand
- Pantai-Gleneagles Hospital, Penang and Sungai Petani, Malaysia
| | - Shona Scott
- Auckland District Health Board, Grafton, Auckland, New Zealand
- Western General Hospital, Edinburgh, UK
| | - Tony Zhang
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | | | - Erica Beilharz
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Stuart R Dalziel
- Auckland District Health Board, Grafton, Auckland, New Zealand
- Department of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Peter Jones
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Kim Yates
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Peter S Bergin
- Auckland District Health Board, Grafton, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
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Recurrent Status Epilepticus: clinical features and recurrence risk in an adult population. Seizure 2022; 97:1-7. [DOI: 10.1016/j.seizure.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 11/22/2022] Open
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Gloss D, Pargeon K, Pack A, Varma J, French JA, Tolchin B, Dlugos DJ, Mikati MA, Harden C. Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary: Report of the AAN Guideline Subcommittee. Neurology 2021; 97:1072-1081. [PMID: 34873018 DOI: 10.1212/wnl.0000000000012944] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 09/24/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To update a 1996 American Academy of Neurology practice parameter. METHODS The authors systematically reviewed literature published from January 1991 to March 2020. RESULTS The long-term (24-60 months) risk of seizure recurrence is possibly higher among adults who have been seizure-free for 2 years and taper antiseizure medications (ASMs) vs those who do not taper ASMs (15% vs 7% per the 1 Class I article addressing this issue). In pediatric patients, there is probably no significant difference in seizure recurrence between those who begin tapering ASMs after 2 years vs 4 years of seizure freedom, and there is insufficient evidence of significant difference in risk of seizure recurrence between those who taper ASMs after 18 months of seizure freedom and those tapering after 24 months. There is insufficient evidence that the rate of seizure recurrence with ASM withdrawal following epilepsy surgery after 1 year of seizure freedom vs after 4 years is not significantly different than maintaining patients on ASMs. An epileptiform EEG in pediatric patients increases the risk of seizure recurrence. ASM withdrawal possibly does not increase the risk of status epilepticus in adults. In seizure-free adults, ASM weaning possibly does not change quality of life. Withdrawal of ASMs at 25% every 10 days to 2 weeks is probably not significantly different from withdrawal at 25% every 2 months in children who are seizure-free in more than 4 years of follow-up. RECOMMENDATIONS Fourteen recommendations were developed.
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Affiliation(s)
- David Gloss
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Kimberly Pargeon
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Alison Pack
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Jay Varma
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Jacqueline A French
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Benjamin Tolchin
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Dennis J Dlugos
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Mohamad A Mikati
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
| | - Cynthia Harden
- From the Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (K.P.), Harbor-UCLA Medical Center, Torrance, CA; Columbia University (A.P.), New York, NY; Department of Neurology (J.V.), Barrow Neurological Institute, Phoenix, AZ; Department of Neurology (J.A.F.), New York University Grossman School of Medicine and NYU Langone Health, New York; Department of Neurology (B.T.), Yale University School of Medicine, New Haven, CT; Departments of Neurology and Pediatrics (D.L.D.), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania; Departments of Pediatrics and Neurobiology (M.A.M.), Duke University Medical Center, Durham, NC; and Xenon Pharmaceuticals (C.H.), Burnaby, Canada
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Gasparini S, Ferlazzo E, Gigli G, Pauletto G, Nilo A, Lettieri C, Bilo L, Labate A, Fortunato F, Varrasi C, Cantello R, D'Aniello A, Gennaro GD, d'Orsi G, Sabetta A, Claudio MTD, Avolio C, Dono F, Evangelista G, Cavalli SM, Cianci V, Ascoli M, Mastroianni G, Lobianco C, Neri S, Mercuri S, Mammì A, Gambardella A, Beghi E, Torino C, Tripepi G, Aguglia U. Predictive factors of Status Epilepticus and its recurrence in patients with adult-onset seizures: A multicenter, long follow-up cohort study. Seizure 2021; 91:397-401. [PMID: 34298459 DOI: 10.1016/j.seizure.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Status epilepticus (SE) is associated with high morbidity and mortality. This multicenter retrospective cohort study aims to identify the factors associated with the occurrence of SE and the predictors of its recurrence in patients with adult-onset seizures. METHODS We retrospectively analyzed data of 1115 patients with seizure onset>18 years, observed from 1983 to 2020 in 7 Italian Centers (median follow-up 2.1 years). Data were collected from the databases of the Centers. Patients with SE were consecutively recruited, and patients without SE history were randomly selected in a 2:1 ratio. To assess determinants of SE, different clinical-demographic variables were evaluated and included in univariate and multivariate logistic regression model. RESULTS Three hundred forty-seven patients had a SE history, whereas the remaining 768 patients had either isolated seizures or epilepsy without SE history. The occurrence of SE was independently associated with increasing age at onset of disease (OR 1.02, 95% CI 1.01--1.03, p<0.001), female sex (OR 1.39, 95% CI 1.05--1.83, p=0.02) and known etiology (OR 3.58, 95% CI 2.61--4.93, p<0.001). SE recurred in 21% of patients with adult-onset SE and recurrence was associated with increasing number of anti-seizure medications taken at last follow-up (OR 1.88, 95% CI 1.31--2.71, p<0.001). CONCLUSIONS In patients with adult-onset seizures, SE occurrence is associated with known etiologies, advanced age and female sex. Patients with recurrent SE are likely to have a refractory epilepsy, deserving careful treatment to prevent potentially fatal events.
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Affiliation(s)
- Sara Gasparini
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Gianluigi Gigli
- Department of Medicine (DAME), University of Udine Medical School, Udine, Italy and Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy; Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Annacarmen Nilo
- Clinical Neurology, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Christian Lettieri
- Neurology Unit, Department of Neurosciences, S. Maria della Misericordia University Hospital, Udine, Italy
| | - Leonilda Bilo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University "Federico II", Napoli, Italy
| | - Angelo Labate
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Francesco Fortunato
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Claudia Varrasi
- Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Roberto Cantello
- Neurology Unit, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Alfredo D'Aniello
- Centre for epilepsy study and treatment, IRCCS "Neuromed", Pozzilli (IS), Italy
| | | | - Giuseppe d'Orsi
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Annarita Sabetta
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Maria T Di Claudio
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Carlo Avolio
- Epilepsy Centre-S.C. Neurologia Universitaria, Policlinico Riuniti, Foggia, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, "D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Sciences, "D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Salvatore M Cavalli
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Michele Ascoli
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Concetta Lobianco
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Sabrina Neri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Sergio Mercuri
- Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy
| | - Anna Mammì
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy
| | - Ettore Beghi
- Laboratory of Neurological Disorders IRCCS "Mario Negri", Milan, Italy
| | - Claudia Torino
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Giovanni Tripepi
- Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension of Reggio Calabria, National Council of Research, Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Bianchi-Melacrino Morelli, Reggio Calabria, Italy.
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Vafaee-Shahi M, Soltanieh E, Saidi H, Riahi A. Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus.Methods:This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study.Results:The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36%versus14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology.Conclusion:Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.
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Abstract
Seizures are a common presentation in both emergency departments and general pediatric practices. Epilepsy affects more than 3.4 million people nationwide, of which approximately 500,000 are children, with greater than 200,000 first-time seizures each year.1 Of the affected individuals, as many as 100,000 are estimated to experience status epilepticus (SE). Both general practitioners and neurologists alike must be able to define, recognize and treat seizure emergencies. This review article defines and describes SE, discusses the emergency evaluation and management of SE that is both new-onset and breakthrough in people with epilepsy, reviews the current treatment recommendations for SE in both the home and hospital settings, and introduces special populations that may be at high risk for SE or other seizure emergencies.
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Affiliation(s)
- Cassandra Kazl
- The Department of Neurology, NYU Langone Health, 240 East 38th Street, New York, NY 10016, United States
| | - Josiane LaJoie
- The Department of Neurology, NYU Langone Health, 240 East 38th Street, New York, NY 10016, United States.
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When and How to Treat Status Epilepticus: The Tortoise or the Hare? J Clin Neurophysiol 2020; 37:393-398. [DOI: 10.1097/wnp.0000000000000656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Sirikarn P, Pattanittum P, Sawanyawisuth K, Tiamkao S. Causes of death in patients with status epilepticus. Epilepsy Behav 2019; 101:106372. [PMID: 31300380 DOI: 10.1016/j.yebeh.2019.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Status epilepticus (SE) is a neurological disorder that affects to the high mortality risk. Several studies reported predictors of mortality in SE; actual causes of death in hospital and out of hospital are limited. This study aimed to describe the case fatality and the causes of death in patients with SE. METHODS This was a descriptive study using the data collected in the national data of the Universal Coverage Scheme in Thailand during the fiscal year 2005 to 2015. Patients who admitted to hospitals and diagnosed as SE were included. The vital status of patients with SE was linked with the Ministry of the Interior and was classified into three phases: in-hospital, short-term, and long-term. RESULTS Among 24,802 patients with SE, 1861 (7.5%) died in hospital, 1910 (7.7%) died within 30 days after hospital discharge, and 4906 (19.8%) died after 30 days. In-hospital death, SE complications (45.9%), seizure (19.6%), and comorbidities (15.4%) were the three common causes of death. While the common causes in short-term and long-term mortality were SE complications (27.7% and 31.0%), comorbidities (28.1% and 26.7%), and other causes (22.4% and 21.9%). CONCLUSION Status epilepticus complications and comorbidities were the common cause of death in patients with SE for all of three periods. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".
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Affiliation(s)
- Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Kittisak Sawanyawisuth
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Research and Training Center for Enhancing Quality of Life of Working Age People, and Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand.
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
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Tuppurainen KM, Ritvanen JG, Mustonen H, Kämppi LS. Predictors of mortality at one year after generalized convulsive status epilepticus. Epilepsy Behav 2019; 101:106411. [PMID: 31668580 DOI: 10.1016/j.yebeh.2019.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Status epilepticus (SE) is a life-threatening neurologic emergency, which requires prompt medical treatment. Little is known of the long-term survival of SE. The aim of this study was to investigate which factors influence 90 days and 1-year mortality after SE. MATERIALS AND METHODS This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with generalized convulsive SE (GCSE) in Helsinki University Central Hospital (HUCH) emergency department (ED) over 2 years. We defined specific factors including patient demographics, GCSE characteristics, treatment, complications, delays in treatment, and outcome at hospital discharge and determined their relation to 90 days and 1-year mortality after GCSE by using logistic regression models. Survival analyses at 1 year after GCSE were performed with Cox proportional hazards regression analysis. RESULTS In-hospital mortality was 7.1%. Mortality rate was 14.3% at 90 days and 24.3% at 1 year after GCSE. In the univariate logistic regression analysis, Status Epilepticus Severity Score > 4 (STESS) (ODDS = 7.30, p = 0.012), worse-than-baseline condition at hospital discharge (ODDS = 3.5, p = 0.006), long delays in attaining seizure freedom (ODDS = 2.2, p = 0.041), and consciousness (ODDS = 3.4, p = 0.014) were risk factors for mortality at 90 days whereas epilepsy (ODDS = 0.2, p = 0.014) and Glasgow Outcome Scale (GOS) >3 at hospital discharge (ODDS = 0.05, p = 0.006) were protective factors. Risk factors for mortality at 1 year were STESS >4 (ODDS = 5.1, p = 0.028), use of vasopressors (ODDS = 8.2, p = 0.049), and worse-than-baseline condition at discharge (ODDS = 7.8, p = 0.010) while GOS >3 (ODDS = 0.2, p = 0.005) was protective. The univariate survival analysis at 1 year confirmed the significant findings regarding parameters STESS >4 (Hazard ratio (HR) = 4.1, p = 0.009), worse-than-baseline condition (HR = 6.2, p = 0.015), GOS >3 (HR = 0.2, p = 0.004) at hospital discharge and epilepsy (HR = 0.4, p = 0.044). Additionally, diagnostic delay over 6 h (HR = 3.8, p = 0.022) and Complication Burden Index (CBI) as an ordinal variable (0-2, 3-6, >6) (HR = 2.7, p = 0.027) were predictive for mortality. In the multivariate survival analysis, STESS > 4 (HR = 5.1, p = 0.007), CBI (HR = 3.2, p = 0.025, ordinal variable), diagnostic delay over 6 h (HR = 7.2, p = 0.003), and worse-than-baseline condition at hospital discharge (HR = 5.8, p = 0.027) were all independent risk factors for mortality at 1 year. CONCLUSIONS Severe form of SE, delayed recognition of GCSE, high number of complications during treatment period, and poor condition at hospital discharge are all independent predictors of long-term mortality. Most of these factors are also associated with mortality at 90 days, though at that point, delays in treatment seem to have a greater impact on prognosis than at 1 year. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
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Affiliation(s)
- Kati Marjatta Tuppurainen
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
| | - Jaakko Gabriel Ritvanen
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
| | - Harri Mustonen
- Department of Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
| | - Leena Sinikka Kämppi
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Central Hospital, Finland.
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Sirikarn P, Tiamkao S, Sawanyawisuth K. Response to comment regarding: "Predictors of long-term mortality in status epilepticus". Epilepsy Behav 2019; 93:151. [PMID: 31036252 DOI: 10.1016/j.yebeh.2018.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022]
Affiliation(s)
| | - Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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Epidemiology-Based Mortality Score is Associated with Long-Term Mortality after Status Epilepticus. Neurocrit Care 2019; 31:135-141. [DOI: 10.1007/s12028-018-0663-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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12
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Sculier C, Gaínza‐Lein M, Sánchez Fernández I, Loddenkemper T. Long-term outcomes of status epilepticus: A critical assessment. Epilepsia 2018; 59 Suppl 2:155-169. [PMID: 30146786 PMCID: PMC6221081 DOI: 10.1111/epi.14515] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 11/29/2022]
Abstract
We reviewed 37 studies reporting long-term outcomes after a status epilepticus (SE) episode in pediatric and adult populations. Study design, length of follow-up, outcome measures, domains investigated (mortality, SE recurrence, subsequent epilepsy, cognitive outcome, functional outcome, or quality of life), and predictors of long-term outcomes are summarized. Despite heterogeneity in the design of prior studies, overall risk of poor long-term outcome after SE is high in both children and adults. Etiology is the main determinant of outcome, and the effect of age or SE duration is often difficult to distinguish from the underlying cause. The effect of the treatment on long-term outcome after SE is still unknown.
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Affiliation(s)
- Claudine Sculier
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Department of NeurologyErasmus HospitalFree University of BrusselsBrusselsBelgium
| | - Marina Gaínza‐Lein
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Faculty of MedicineAustral University of ChileValdiviaChile
| | - Iván Sánchez Fernández
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
- Department of Child NeurologyHospitalSant Joan de Déu, Universidad deBarcelonaSpain
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical NeurophysiologyDepartment of NeurologyBoston Children's HospitalHarvard Medical SchoolBostonMassachusetts
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Tiamkao S, Buranakul N, Saybungkla P, Sirikarn P, Sawanyawisuth K. Risk score predictive of mortality in status epilepticus according to a national database. Epilepsia 2018; 59 Suppl 2:182-187. [PMID: 30159871 DOI: 10.1111/epi.14489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Abstract
Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD-10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors-associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41-60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21-40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver-operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.
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Affiliation(s)
- Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Nattakarn Buranakul
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Pawinee Saybungkla
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.,Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Doctor of Philosophy Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Tiamkao S, Saybungkla P, Sirikarn P, Sawanyawisuth K. Predictors of long-term mortality in status epilepticus. Epilepsy Behav 2018; 84:114-117. [PMID: 29778845 DOI: 10.1016/j.yebeh.2018.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND There were several studies that have reported on the long-term mortality rate of status epilepticus (SE). However, these studies were conducted mainly in Western countries using small study populations. This study aimed to evaluate predictors for long-term mortality in SE using the Thai national healthcare database. METHODS This study was conducted using the Thai national Universal Health Coverage (UC) database. The eligibility criteria for this study were that all patients were diagnosed with SE and had been admitted to any hospital between 2005 and 2015. Mortality was defined at discharge and at one, three, five, and 10 years. All eligible patients were categorized as either having survived or having died. The mortality rates were calculated at one, three, five, and 10 years. Factors associated with mortality were analyzed using backward multivariate Cox proportional hazard regression analysis. Kaplan-Meier was performed to estimate the survival rate. RESULTS During the study period, there were 21,732 patients with SE admitted who met the study criteria. The total observation time was 85,821.28 person-years. Of the patients enrolled, 3642 (or 4.24 per 100 person-years [95% confidence interval (CI): 4.11-4.38]) died. Factors positively associated with mortality in patients with SE were central nervous system (CNS) infection, cancer, heart diseases, chronic renal failure, septicemia, pneumonia, respiratory failure, acute renal failure, and shock. Heart diseases had the highest adjusted hazard ratio at 2.69 (95% CI: 2.47-2.93). Two factors were negatively related with SE mortality: hypertension and urinary tract infection. CONCLUSION Long-term mortality in patients with SE had both positive and negative predictors in the national database.
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Affiliation(s)
- Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Pawinee Saybungkla
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand; Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Atmaca MM, Bebek N, Baykan B, Gökyiğit A, Gürses C. Predictors of outcomes and refractoriness in status epilepticus: A prospective study. Epilepsy Behav 2017; 75:158-164. [PMID: 28866335 DOI: 10.1016/j.yebeh.2017.07.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the predictors of outcomes and refractoriness in status epilepticus (SE). METHODS This is a prospective study of 59 adult patients with SE who were admitted to the Emergency Department between February 2012 and December 2013. The effects of clinical, demographic, and electrophysiologic features of patients with SE were evaluated. To evaluate outcome in SE, STESS, mSTESS, and EMSE scales were used. RESULTS Logistic regression analysis showed that being aged ≥65years (p=0.02, OR: 17.68, 95% CI: [1.6-198.4]) for the short term and having potentially fatal etiology (p=0.027, OR: 11.7, 95% CI: [1.3-103]) for the long term were the only independent predictors of poor outcomes; whereas, the presence of periodic epileptiform discharges (PEDs) in EEG was the only independent predictor of refractoriness (p=0.032, OR: 13.7, 95% CI: [1.3-148.5]). The patients with ≥3 Status Epilepticus Severity Score (STESS) did not have poorer outcomes in the short- (p=0.157) and long term (p=0.065). There was no difference between patients with 0-2, 3-4, and ≥4 mSTESS in the short- and long term in terms of outcome (p=0.28 and 0.063, respectively). Also, there was no difference between subgroups (convulsive SE [CSE], nonconvulsive SE [NCSE], and epilepsia partialis continua [EPC]) in terms of STESS and mSTESS. When patients with EPC were excluded, both STESS and mSTESS scores of the patients correlated with poorer long-term outcomes (p=0.025 and 0.017, respectively). The patients with ≥64 points in the Epidemiology-based Mortality in SE-Etiology, age, comorbidity, EEG (EMSE-EACE) score and those with ≥27 points in EMSE-Etiology, age, comorbidity (EMSE-EAC) score did not have poorer outcomes in the short term (p=0.06 and 0.274, respectively) while they had significantly poorer outcome in the long term (p<0.001 and 0.002, respectively). In subgroup analysis, patients with CSE with ≥64 points in EMSE-EACE had significantly poorer outcome in the both short- and long term (p=0.014 and 0.012, respectively), and patients with CSE with ≥27 points in EMSE-EAC had significantly poorer outcome in the long term (p=0.03) but not in the short term (p=0.186). Outcomes did not correlate with EMSE scores in patients with NCSE and EPC. Status epilepticus was terminated with intravenous (IV) levetiracetam (LEV) in 68.75% of patients and with IV phenytoin (PHT) in 83.3% of patients. No statistically significant difference was found between the two groups in terms of efficacy (p=0.334). CONCLUSION Being aged ≥65years predicts poor short-term outcomes, and having potentially fatal etiology predicts poor long-term outcomes, which highlight the importance of SE treatment management in the elderly. Both STESS and mSTESS are not predictive for poor outcomes in EPC. Excluding patients with EPC, STESS, and mSTESS could predict poor long-term outcomes but not in the short term in SE. Epidemiology-based Mortality in Status Epilepticus score could predict poor outcome in the long term better than STESS and mSTESS. Specifically, EMSE scores correlated with poor outcome in patients with CSE but not with NCSE and EPC. New scales are needed to predict outcome especially in patients with NCSE and EPC. The presence of PEDs in EEG is a predictor of RSE, and EMSE score can also be used to predict RSE. There was no difference in the efficacy of IV LEV and IV PHT in SE. This study is significant for having one of the longest follow-up periods in the literature.
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Affiliation(s)
- Murat Mert Atmaca
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
| | - Nerses Bebek
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
| | - Ayşen Gökyiğit
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey
| | - Candan Gürses
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Turkey.
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Lv RJ, Wang Q, Cui T, Zhu F, Shao XQ. Status epilepticus-related etiology, incidence and mortality: A meta-analysis. Epilepsy Res 2017; 136:12-17. [PMID: 28734267 DOI: 10.1016/j.eplepsyres.2017.07.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/11/2017] [Accepted: 07/02/2017] [Indexed: 10/19/2022]
Abstract
Status epilepticus (SE) is a severe medical condition. To determine its epidemiology and outcome of SE, we performed a meta-analysis to investigate the etiology, incidence and mortality of SE. We searched PubMed and Embase between Jan 1, 2000, and Oct 31, 2016, with no regional restrictions, for observational studies of the etiology, incidence and mortality of SE. Forty-three studies were included in the meta-analysis. The pooled crude annual incidence rate, the pooled case fatality rate and the pooled crude annual mortality rate of SE were 12.6/100,000 (95% CI: 10.0-15.3), 14.9% (95% CI: 11.7-118.7) and 0.98/100,000 (95% CI: 0.74-1.22), respectively. Elderly subjects with SE had a higher case fatality rate (28.4% (95% CI: 17.7-42.3)) and crude annual incidence rate (27.1% (95% CI: 15.8-38.2)). The most important etiology-specific attributable fraction of patients with SE was acute symptomatic etiology (OR 0.411, 95% CI: 0.315-0.507). Age and economic income contributed to differences in SE incidence and short-term case fatality rate.
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Affiliation(s)
- Rui-Juan Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing, PR. China, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Qun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing, PR. China, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Tao Cui
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing, PR. China, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Fei Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing, PR. China, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China
| | - Xiao-Qiu Shao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China; China National Clinical Research Center for Neurological Diseases, Beijing, PR. China, 6 Tiantanxili, Dongcheng District, Beijing, 100050, China.
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Predictive value of the Status Epilepticus Severity Score (STESS) and its components for long-term survival. BMC Neurol 2016; 16:213. [PMID: 27816063 PMCID: PMC5097843 DOI: 10.1186/s12883-016-0730-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/20/2016] [Indexed: 12/02/2022] Open
Abstract
Background The “Status Epilepticus Severity Score” (STESS) is the most important clinical score to predict in-hospital mortality of patients with status epilepticus (SE), but its prognostic relevance for long-term survival is unknown. This study therefore examined if STESS and its components retain their prognostic relevance beyond acute treatment. Methods One hundred twenty-five non-anoxic patients with SE were retrospectively identified in two hospitals between 2008 and 2014 (39.2 % refractory SE). Patients’ treatment, demographic data, date of death, aetiology of SE, and the components of the STESS (age, history of seizures, level of consciousness and worst seizure type) were determined based on the patients’ records. Results In 94.4 % of patients, SE was treated successfully; in-hospital mortality rate was 12 %. The overall mortality was 42 % after median follow-up of 28.1 months. The survival plateaued after about 3 years, all patients with progressive brain diseases (n = 4) died within one year. In-hospital mortality correlated highly significantly with STESS, the optimal cut-off was 4. With respect to long-term outcome, STESS correlated significantly with overall mortality though with lower odds ratios. When looking only at patients that survived the acute phase of treatment, only the STESS components “level of consciousness” (at admission), “coma” as worst seizure type, and “age” reached a statistical significant association with mortality. In these patients, STESS with a cut-off of 4 was not significantly associated with survival/mortality. Aetiology of SE was insufficient to explain the weak association and the high mortality after discharge alone. Conclusion STESS at onset of SE reliably assessed in-hospital mortality, and was indicative for overall survival. However, STESS did not allow correct estimation of mortality after discharge. The high mortality after discharge and high overall mortality of patients diagnosed with SE was not explained by progressive brain disorders alone. Further research is needed to understand the causes for high overall mortality after SE and putative prognostic factors. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0730-0) contains supplementary material, which is available to authorized users.
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Malek AM, Wilson DA, Martz GU, Wannamaker BB, Wagner JL, Smith G, Edwards JC, Selassie AW. Mortality following status epilepticus in persons with and without epilepsy. Seizure 2016; 42:7-13. [DOI: 10.1016/j.seizure.2016.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/11/2016] [Accepted: 08/30/2016] [Indexed: 11/17/2022] Open
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Cheng JY. Latency to treatment of status epilepticus is associated with mortality and functional status. J Neurol Sci 2016; 370:290-295. [PMID: 27772779 DOI: 10.1016/j.jns.2016.10.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/01/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Status epilepticus (SE) is a life-threatening neurologic emergency. Despite advances in management, in-hospital mortality remains unchanged. This is partly due to the pharmacoresistance which develops the longer that seizures persist. Therefore, rapid antiseizure medication (ASM) administration may represent a beneficial treatment option. The purpose of this study was to determine: 1) whether in-hospital mortality is reduced with shorter latencies to initial treatment of SE with an ASM (LTSE); and 2) the critical time frame during which LTSE is associated with reduced in-hospital mortality. MATERIALS AND METHODS This was a retrospective, single-center study of adults diagnosed with SE between 1/1/2005 and 10/31/2012. Demographic characteristics included seizure history, etiology, semiology, and duration. Subjects were assigned to LTSE groups at the time frames of 5, 10, 30 and 60min. The primary outcome was in-hospital mortality, with poor functional status (mRS 3-6) as a secondary measure. Pearson's chi-square, Mann-Whitney-U, two-sample-t-tests, and binary logistic regression analysis were used as appropriate, with p<0.05. RESULTS In unadjusted analysis, LTSE>30min demonstrated increased risk of mortality (OR 2.06, CI 1.01-4.17, p=0.046) and poor functional status (OR 2.48, CI 1.05-5.85, p=0.038) compared to LTSE≤30min. Increased mortality risk remained after adjusting for SE duration (OR 2.07, CI 1.01-4.26, p=0.047) and nonconvulsive seizures (OR 2.28, CI 1.08-4.80, p=0.03). Compared to subjects treated within 60min, those treated after 60min were at increased risk of poor functional status, regardless of the presence of nonconvulsive seizures (OR 2.96, CI 1.14-7.73, p=0.026). In addition, when acute symptomatic SE was stratified by cardiac versus non-cardiac etiologies, subjects with non-cardiac acute symptomatic SE demonstrated worse functional outcome when treated after 60min (OR 7.20, CI 1.13-46.07, p=0.037). CONCLUSIONS Treatment of SE within 30min of onset is associated with reduced risk of in-hospital mortality and poor functional status, although this may be attenuated by acute symptomatic seizures related to cardiac arrest. This represents a therapeutic option which has the potential to benefit patient outcomes.
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Affiliation(s)
- Jocelyn Y Cheng
- NYU Langone Comprehensive Epilepsy Center, NYU School of Medicine, 223 E. 34th Street, New York, NY 10016, USA; Drexel University College of Medicine, Department of Neurology, 245 N. 15th Street, MS 423, Philadelphia, PA 19102, USA.
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Moghaddasi M, Joodat R, Ataei E. Evaluation of Short-term Mortality of Status Epilepticus and Its Risk Factors. J Epilepsy Res 2015; 5:13-6. [PMID: 26157668 PMCID: PMC4494989 DOI: 10.14581/jer.15003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/28/2015] [Indexed: 11/05/2022] Open
Abstract
Background and Purpose: Status epilepticus (SE) is defined as epileptic seizures of greater than five minutes or more than one seizure within a five minute period without returning to normal consciousness between them. It is a life-threatening condition particularly if treatment is delayed. Previous studies reported age, duration and etiology of SE as primary determinants of mortality. Methods: This prospective cross-sectional study performed on the patients with status epilepticus admitted in Rasoul-e-Akram hospital in Tehran. Patients followed at 30th day after SE to assess their living status. Results: Sixty-five patients, (56.9% was male) with 15 to 88 years of age entered the study. Mean duration of SE was 40 minutes and for hospital stay was 7 days. 84.6% of patients responded to treatment and 11 patients (16.9%) died within 30 days after SE. Mortality rate in patients with refractory SE was 70%. Mean interval between SE and death was 11.9 ± 11.7 days. Age, duration of SE and hospital stay, history of head trauma and neurosurgery were not predictors of mortality. Negative history for epilepsy had significantly higher mortality rate. Anoxic encephalopathy increased the mortality rate and response to treatment decreased it. Conclusions: Short-term mortality rate of SE was comparable with most of the previous reports Since our hospital has equipped emergency department, resuscitation and primary treatment of SE is usually start soon, percentage of anoxic encephalopathy is decreased and lower mortality rate is expected. We conclude that early treatment by decrease chance of anoxic encephalopathy, has significant role in outcome of SE.
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Affiliation(s)
- Mehdi Moghaddasi
- Associate Prof. of Neurology, Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Rashin Joodat
- Medical Intern, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Ataei
- Rasool Akram Hospital Neurology, Iran University of Medical Sciences, Tehran, Iran
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