Clinical Implications of Status Epilepticus in Patients With Neoplasms

Abstract

Main Outcome Measures: Seizure control, 30-day mortality, and overall survival. Results: Status epilepticus most commonly occurred at tumor presentation or progression and was controlled in all cases. Thirty-day mortality was 23%. Patients with systemic cancer were at higher risk of death, although they were older and had more acute comorbidities. Age, tumor type, status of tumor at time of event, history of epilepsy, and status type were not predictive of mortality. Age was associated with a higher rate of nursing home placement and shorter overall survival. Overall survival was determined by underlying tumor. Conclusions: Status epilepticus in patients with cancer is responsive to therapy. Workup of underlying causes is indicated, even in the presence of subtherapeutic antiepileptic drug levels, because coexistent conditions contributing to the development of SE may be present. In those with known cancer, brain imaging should be performed because SE usually occurs in the setting of tumor progression or new metastases.

Status Epilepticus Severity Score (STESS)

“…Indeed, in our model, "potentially fatal etiology" appears better suited to predict bad outcome as compared to the classically used "acute symptomatic" classification [1]. The latter, proposed in detail in 1993, raises problems especially regarding patients with SE following antiepileptic drug withdrawal or minor intercurrent infections, which are categorized as "acute symptomatic," but usually do not have a high mortality risk; conversely, malignant tumors may have a major impact on short-term prognosis of SE [3], yet they are officially labeled as "progressive symptomatic".…”

Seizures and epilepsy in cancer: Etiologies, evaluation, and management

“…However, the most common cause for aggravation of seizures in patients with epilepsy is poor compliance with medications [46], which represents the greatest risk factor for status epilepticus [47].…”

Avancées dans les tumeurs cérébrales primitives malignes de l’adulte : quels patients transférer en réanimation médicale?

“…En effet, un patient présentant une TCPM peut s'aggraver avec l'apparition d'une défaillance neurologique lors de crises comitiales ou d'un état de mal comitial [40][41][42][43][44], d'une progression tumorale plus ou moins rapide intraparenchymateuse ou méningée, d'une hémorragie cérébro-méningée et d'hydrocéphalie aiguë responsable d'une hypertension intracrânienne. Dans notre expérience, l'hospitalisation en réani-mation pour un état de mal comitial et/ou de crises comitiales représente près de 40 % des admissions en réanimation chez les patients admis pour TCPM (données non publiées).…”

“…témozolomide) ; (iv) d'une insuffisance rénale aiguë (e.g. méthotrexate) [40] ; (v) d'une insuffisance cardiaque (e.g. anthracyclines) ; (vi) d'une hémorragie (e.g.…”