Determinants of Mortality in Status Epilepticus

Abstract

Using univariate and multivariate regression analysis, we studied seizure duration, seizure type, age, etiologies, other clinical features, and mortality among 253 adults with status epilepticus (SE) admitted to the Medical College of Virginia. Cerebral vascular disease and discontinuation of antiepileptic drugs (AEDs) were the most prominent causes of SE, each accounting for approximately 22% of all patients in the series. The other principle etiologies were alcohol withdrawal, idiopathic, anoxia, metabolic disorders, hemorrhage, infection, tumor, drug overdose, and trauma. When the patients were divided into two groups, the group with SE lasting < 1 h had a lower mortality as compared with seizure duration > or = 1 h. Low mortality rates were noted in alcohol and AED discontinuation etiologies. Anoxia and increasing age were significantly correlated with higher mortality. The mortality rates of partial and generalized SE were not significantly different. Race and sex did not affect mortality significantly. Our findings represent the first multivariate analysis of predictive indicators of mortality in SE and demonstrate that specific factors influence mortality rate in SE.

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

“…Confirming prior studies of SE, we found mortality to be associated with older age (54,55), etiology (54)(55)(56)(57)(58)(59), seizure duration (55,57), and APACHE-2 scores (7).…”

Early withdrawal of non-anesthetic antiepileptic drugs after successful termination of nonconvulsive seizures and nonconvulsive status epilepticus

“…Our data demonstrates that AED weaning did not influence patient discharge disposition, with discharges being evenly distributed between favorable (home, acute rehabilitation), acceptable (SNF, LTACH) and unfavorable (death, hospice) outcomes. Approximately one third of patients died or went to hospice, which is not surprising given that NCS/NCSE in ICU patients is associated with increased mortality and worsened outcome [32], and is in keeping with previous studies that reported mortality rates of about 30% for critically ill patients with seizures lasting greater than one hour [33]. However, the rate of poor outcomes does not appear to be influenced by AED discontinuation.…”

Ketamine controls prolonged status epilepticus

“…Prolonged status epilepticus has a higher mortality rate than brief episodes (Towne et al, 1994;DeLorenzo et al, 1995), and is refractory to many currently used medications (Yaffe and Lowenstein, 1993). In clinical testing, lorazepam was more effective than phenytoin in controlling brief overt convulsive status epilepticus (Treiman et al, 1998).…”