Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

Abstract

Summary Objective Status epilepticus (SE) is an important medical emergency condition with particularly unfavorable outcome in refractory and superrefractory SE (SRSE). The economic impact of SE and especially of SRSE in the pediatric population remains unclear. We aimed to determine the burden of illness of SE in a pediatric patient population. Methods Insurance records for patients aged 0‐18 years admitted between 2008 and 2015 were selected from a nationwide insurance research database utilizing International Classification of Diseases and Related Health Problems, 10th Revision (ICD‐10) codes for SE (G41), epilepsy (G40), or febrile convulsions (R56). Patients were further classified based on admission to the intensive care unit and use of mechanical ventilation. Results The algorithm identified 11 693 seizure‐related admissions and classified 4% as SE. Of these cases, 282 (60.4%) were classified by the algorithm as nonrefractory SE (NRSE), 125 (26.8%) as refractory SE (RSE), and 60 (12.8%) as SRSE. The crude SE incidence was 17.6/100 000, with NRSE being 11.4/100 000, RSE 3.9/100 000, and SRSE 2.3/100 000. SRSE incidence peaked in the 0‐ to 1‐year‐old age subgroup accounting for 48.3% of all pediatric SRSE admissions. The median length of stay (LOS) for all SE cases was 7 days, with median 44.5 days in SRSE, 5 days in NRSE, and 12 days in RSE. Mean admission costs for total SE were €15 880, with a mean expense for SRSE of €75 358, for NRSE of €4119, and for RSE of €13 864. The mean LOS for non‐SE epilepsy admissions was 3 days, with mean costs of €2697 for epilepsy and €1614 for febrile convulsion admissions. There were no deaths in non‐SE and NRSE admissions, whereas the overall mortality for SE was 3%, with 5.6% in RSE and 11.7% in SRSE. Significance Although cases classified as SE represented 4% of the seizure‐associated admissions, they accounted for 22% of the overall costs. These costs were disproportionately represented by SRSE cases, which accounted for 62% of all SE‐associated costs.

A multicenter, matched case‐control analysis comparing burden‐of‐illness in Dravet syndrome to refractory epilepsy and seizure remission in patients and caregivers in Germany

“…This study did not explore in detail whether the differences between DRE and DS patients can be explained by a difference in seizure frequency, seizure semiology or seizure duration (status epilepticus), or by DS patients having more additional symptoms. Although more patients in the DS cohort experienced seizures at a shorter frequency, whether and to what extent this accounts for the higher socioeconomic impact of the disease is beyond the scope of this comparative analysis (matching of patients by seizure frequency would not be possible because of the small sample sizes).…”

Treatment of refractory and superrefractory status epilepticus with topiramate: A cohort study of 106 patients and a review of the literature

“…[1][2][3][4][5] Refractory SE (RSE) and superrefractory SE (SRSE) are characterized by the failure of first-, second-, and third-line therapy and, in the latter case, anesthetic therapy. It requires instant medical intervention and is accompanied by prolonged hospital stays and increased health care costs.…”

“…It requires instant medical intervention and is accompanied by prolonged hospital stays and increased health care costs. [1][2][3][4][5] Refractory SE (RSE) and superrefractory SE (SRSE) are characterized by the failure of first-, second-, and third-line therapy and, in the latter case, anesthetic therapy. 1,6 There are few controlled or randomized study data on RSE and SRSE, so that the basis of therapeutic management frequently relies on expert opinion, clinical reports, and pathophysiological assumptions arising from experimental data.…”

Seizure management and prescription patterns of anticonvulsants in Dravet syndrome: A multicenter cohort study from Germany and review of literature

“…After disease onset, patients may experience episodes of status epilepticus (SE) at any age, although the incidence peaks in the first decade of life [5]. Furthermore, ongoing episodes of SE will have a negative impact on the overall outcome [6,7].…”