Occurrence of status epilepticus in persons with epilepsy is determined by sex, epilepsy classification, and etiology: a single center cohort study

Langenbruch, Lisa; Strippel, Christine; Görlich, Dennis; Elger, Christian E.; Möddel, Gabriel; Meuth, Sven G.; Kellinghaus, Christoph; Wiendl, Heinz; Kovač, Stjepana

doi:10.1007/s00415-021-10600-y

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…13 Neurological comorbidities were found in 21.7% of patients and non-neurologic systemic comorbidities varied, consistent with the profile reported in a high complexity German center. 22 The majority of our patients had one brain image (57.6%), a higher percentage when compared with the Polish study already mentioned, which reported that brain imaging was performed in less than 20% of patients, and brain magnetic resonance was performed only in 1 patient. As electroencephalography, more recordings performed in our study (32.6%) when compared with the by Stawińska-Witoszyńska (11.1%).…”

Section: Discussionmentioning

confidence: 47%

“…However, when considering only the hospitalized population, this subgroup would account for 18.69%, a proportion that is lower than reported in a recent study in a German population explicitly aimed at finding patients with a history of status epilepticus over their lifetime and which reported an amount of 34.6% of the total number of patients. 22 It is worth highlighting that no questions about a history of status epilepticus was explicitly asked during outpatient assessments, which would explain, at least in part, the low percentage of occurrence of this phenomenon in our group of patients, given that only the hospitalized population would be represented.…”

Section: Discussionmentioning

confidence: 99%

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Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross‐sectional study

Ríos Patiño,

Morcillo Muñoz,

Lorenzana Pombo

et al. 2024

Epilepsia Open

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ObjectiveTo describe the sociodemographic and clinical characteristics of imprisoned patients with epilepsy seen at Samaritana University Hospital (HUS) in Bogotá D.C., between January 2017 and November 2020.MethodsCross‐sectional cohort study of inmate patients over 18 years of age seen at HUS between January 2017 and November 2020, with a discharge diagnosis of epilepsy. A descriptive univariate analysis of patient sociodemographic and clinical characteristics was carried out.ResultsOverall, 92 patients were included, 95.7% were males with a median age of 32 years (IQR: 26–44); 65% were assessed in the outpatient clinic; median hospital length of stay was 2 days (IQR: 0) and 7.6% required admission to the intensive care unit; 75% had focal onset epilepsy, 63.04% with undetermined etiology 31.52% with structural causes. Polytherapy was found in 53.3%, valproic acid being the most frequently used antiseizure medication in 59.78%; lack of adherence was reported in 15.22% and inadequate seizure control in 81.52%; status epilepticus occurred in 5.34%. A total of 31 EEG recordings and 53 brain images were performed, of which, 29% and 39.62%, respectively, were abnormal. Non‐epileptic paroxysmal events were diagnosed in 5.34%, while organic or psychiatric comorbidities were found in 25%, and the use of psychoactive substances was documented in 17.39%. Upon discharge, 93.47% had no disability, and only 45.65% returned for outpatient follow‐up.SignificanceThe clinical profile was of men in the fourth decade of life with focal onset epilepsy characterized by high seizure frequency, most of whom were receiving antiseizure medication, with a high proportion of polytherapy. The results are a point of departure for prospective studies designed to identify points to intervene and improve healthcare for inmates with epilepsy.Plain Language SummaryInmates are a vulnerable proportion of persons with epilepsy. In this group there are significant differences compared to the general population, especially with greater psychiatric comorbidity and worse control of epileptic seizures due to difficulties in accessing medical care, antiseizure medication and diagnostic tests. We found that the most characteristic population is made up of men in the fourth decade of life with a high frequency of seizures, most of whom were receiving multiple antiseizure medication This study is the first of its kind in Latin America and it is an initial approach to epilepsy in inmates.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross‐sectional study

Ríos Patiño,

Morcillo Muñoz,

Lorenzana Pombo

et al. 2024

Epilepsia Open

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“…Not surprisingly, biological sex and sex-specific thresholds as estimates of organ dys/function (SAPS II) are not included in ICU risk assessment tools, and may thus underestimate illness severity in women, given their lower thresholds in most biomarkers. Accordingly, earlier studies have described female sex as an important promotor of the emergence of SE in patients with epilepsy [ 3 ] and that female sex is associated with a higher mortality in SE [ 32 ]. This is a serious and worrisome hypothesis which warrants further studies, including careful reassessment of contemporary risk assessment tools in order to provide equal opportunities to men and women [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, studies regarding the role of sex on the emergence of SE, its treatment, course, and outcome are scarce. Although some studies have suggested that female sex may be a risk factor for the development of SE in patients with epilepsy [ 3 ], and that women may receive less aggressive care than men regardless of illness severity [ 4 ], other studies have reported conflicting findings. For example, early studies suggested that the incidence of SE was lower in women than men, and other studies found no significant sex-related differences regarding the incidence of SE [ 5 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation

Baumann,

De Stefano,

Kliem

et al. 2023

Crit Care

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Background Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers. Methods In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women. Results Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004). Conclusions This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.

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“…ASM was prescribed to control seizures in the acute phase, and a larger number of ASMs was related to increased seizure severity and worse autoimmune processes in the acute phase, which may contribute to the development of epilepsy after the acute phase. It was recently reported that patients with epilepsy who had a history of status epilepticus were more likely to receive a larger number of ASMs than those without a history of status epilepticus ( 21 ). Thus, it is not surprising that in AE patients, a larger number of ASMs may be related to the occurrence of status epilepticus, which was also identified as a risk factor for the development of epilepsy in the univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Acute Symptomatic Seizures and Risk of Epilepsy in Autoimmune Encephalitis: A Retrospective Cohort Study

et al. 2022

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PurposeTo investigate the clinical characteristics of acute symptomatic seizures and the predictors of the development of epilepsy in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis.MethodsWe retrospectively screened the medical records of 86 hospitalized patients with confirmed autoimmune encephalitis (AE). The clinical characteristics of acute symptomatic seizures were analyzed. The predictors of the development of epilepsy were investigated using logistic regression analysis.ResultsA total of 86 patients with AE were finally included. Eighty-six percent of patients (n = 74) experienced acute symptomatic seizures, and 28.4% of patients developed epilepsy during follow-up. Abnormal EEG findings were more frequent in AE patients with acute symptomatic seizures. A greater number of anti-seizure medications (ASMs), abnormal EEG findings, and delayed immunotherapy were found to be independently associated with the development of epilepsy.ConclusionAcute symptomatic seizures are a common manifestation in AE patients. During follow-up, 28.4% of AE patients developed epilepsy. The independent factors that predicted the development of epilepsy after the acute phase included a larger number of ASMs, EEG abnormalities, and delayed immunotherapy. In clinical practice, we should prioritize immunotherapy to control acute seizures as soon as possible. For AE patients with an increased risk of developing epilepsy, early withdrawal of ASM is not recommended.

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Occurrence of status epilepticus in persons with epilepsy is determined by sex, epilepsy classification, and etiology: a single center cohort study

Cited by 7 publications

References 19 publications

Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross‐sectional study

Epilepsy in inmate patients seen in a high complexity reference hospital in Colombia: A cross‐sectional study

Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation

Acute Symptomatic Seizures and Risk of Epilepsy in Autoimmune Encephalitis: A Retrospective Cohort Study

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