Clinical characteristics and outcomes of patients with recurrent status epilepticus episodes

Abstract

Background Multiple studies have focused on medical and pharmacological treatments and outcome predictors of patients with status epilepticus (SE). However, a sufficient understanding of recurrent episodes of SE is lacking. Therefore, we reviewed recurrent SE episodes to investigate their clinical characteristics and outcomes in patients with relapses. Methods In this retrospective, multicenter study, we reviewed recurrent SE patient data covering 2011 to 2017 from the university hospitals of Frankfurt and Marburg, Germany. Clinical characteristics and outcome variables were compared among the first and subsequent SE episodes using a standardized form for data collection. Results We identified 120 recurrent SE episodes in 80 patients (10.2% of all 1177 episodes). The mean age at the first SE episode was 62.2 years (median 66.5; SD 19.3; range 21–91), and 42 of these patients were male (52.5%). A mean of 262.4 days passed between the first and the second episode. Tonic–clonic seizure semiology and a cerebrovascular disease etiology were predominant in initial and recurrent episodes. After subsequent episodes, patients showed increased disability as indicated by the modified Rankin Scale (mRS), and 9 out of 80 patients died during the second episode (11.3%). Increases in refractory and super-refractory SE (RSE and SRSE, respectively) were noted during the second episode, and the occurrence of a non-refractory SE (NRSE) during the first SE episode did not necessarily provide a protective marker for subsequent non-refractory episodes. An increase in the use of intravenous-available anti-seizure medication (ASM) was observed in the treatment of SE patients. Patients were discharged from hospital with a mean of 2.8 ± 1.0 ASMs after the second SE episode and 2.1 ± 1.2 ASMs after the first episode. Levetiracetam was the most common ASM used before admission and on discharge for SE patients. Conclusions This retrospective, multicenter study used the mRS to demonstrate worsened outcomes of patients at consecutive SE episodes. ASM accumulations after subsequent SE episodes were registered over the study period. The study results underline the necessity for improved clinical follow-ups and outpatient care to reduce the health care burden from recurrent SE episodes.

Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review

“…SE can lead to cell damage, neuronal death, neuronal injury, or alteration of neuronal networks, depending on seizure type. Therefore, prompt seizure termination and prevention of recurrence is crucial in these cases [ 11 – 13 ].…”

Fenfluramine for the treatment of status epilepticus: use in an adult with Lennox–Gastaut syndrome and literature review

“…Therapeutic management beyond the use of benzodiazepines and common ASMs is based on clinical reports, expert opinion, and pathophysiological assumptions from experimental data. Patients with developmental and epileptic encephalopathies (DEEs) such as Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS) frequently experience convulsive and non-convulsive SE [ 5 , 6 ], and their treatment is more challenging because some ASMs may exacerbate seizures and SE, including sodium channel blockers in DS [ 7 , 8 ].…”