Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality

Abstract

We retrospectively reviewed the clinical course of 66 patients treated for generalized tonic-clonic status epilepticus at the Ege University neurological intensive care unit from 1988 to 1997. Seventy-two per cent of the study group had a pre-existing seizure disorder, and antiepileptic drug withdrawal was the most prominent cause of status epilepticus. The other causes included drug toxicity, central nervous system infection, cerebrovascular disease, tumour and trauma. Seventy-three per cent of all patients responded to the first-line therapy (diazepam and/or phenytoin), and the remainder were considered to have refractory status epilepticus and required pentobarbital anaesthesia. Overall case fatality was 21%, but death could be attributed directly to status epilepticus and/or treatment complication in 10% of the study group. Major determinants of fatal outcomes were: increasing age, longer duration of status epilepticus before initiation of therapy and central nervous system infection as a causal factor.

Etiology and prognosis of non-convulsive status epilepticus

“…Although some studies have described a positive correlation between poor recovery and delay in treatment initiation in NCSE patients [29], the long-term effects of aggressive treatment in such patients has not been documented to our knowledge [14]. Since our study period preceded the recognition of auto-immune bases for SE, these type of diseases could not considered as an etiology of NCSE.…”

Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain Tumors

“…In a study by Moots et al [5] 26% of patients with brain tumors and epilepsy developed status epilepticus (SE). Furthermore, up to 20% of adult patients with SE have brain tumors as the cause of SE [6][7][8][9][10][11]. The overall mortality rate from SE of all causes remains high at 15-23% [6,7,11]; however, the mortality is even higher, 30-40%, in brain tumor patients [7,11,12].…”

Impact of treatment on the short-term prognosis of status epilepticus in two population-based cohorts

“…Male gender [13], longer duration of SE [22,25], continuous SE (versus intermittent form) [25] were pointed out by only some studies. Other independent factors from single hospital series are delay to treatment [10,19], need for ventilation [19] and stupor or coma at presentation [18].…”