High long‐term mortality after incident status epilepticus in adults: Results from a population‐based study

Abstract

Objective:To determine annual incidence, etiology, severity, and short-and long-term mortality of first-time, nonanoxic status epilepticus (SE) in adults in a population-based retrospective cohort study. Methods: We systematically identified all episodes of SE in the year 2014 on the island of Funen. Patients with SE due to anoxia, patients with recurrent SE, and patients <18 years old were excluded. Nonconvulsive SE in coma was diagnosed according to the Salzburg criteria. Etiology, semiology, modified Rankin Scale (mRS) at discharge, survival, and the Status Epilepticus Severity Score were retrospectively determined from patients' records. Patients with first-time nonanoxic SE diagnosed during 2008-2013 from our database (n = 88) were used to confirm the results. Results: The incidence of first-time, nonanoxic SE in 2014 was 10.7/100 000 persons at risk (n = 41). Median Status Epilepticus Severity Score was 3; in-hospital mortality was 24.4%. After median follow-up of 39.2 months, 53.7% of the patients had died (age-and gender-adjusted mortality rate of 5.2/100 000). Mortality stabilized 2 years after diagnosis. Analysis of the cohort from 2008-2013 confirmed stabilization of survival after 2-3 years and the high mortality 2 years after discharge. When correcting for acute symptomatic causes, the in-hospital mortality was 16.7% and 46.7% at follow-up (crude mortality rate of nonhypoxic and nonacute symptomatic SE = 3.5/100 000). An exploratory multivariate analysis of pooled patients with SE from 2008 to 2014 revealed mRS ≥ 2 at discharge as a prognostic factor for long-term mortality. Significance: In this cohort, the overall mortality of first-time nonhypoxic SE was >50%. Mortality of SE after discharge was substantially higher than in-house mortality and stabilized after 2 years. The degree of disability as indicated by mRS at discharge was associated with long-term mortality after discharge. K E Y W O R D Slong-term outcome, long-term survival, population-based, prognosis, status epilepticus, STESS

Epidemiology of status epilepticus in adults: Apples, pears, and oranges — A critical review

“…Twenty-two studies, ten prospective and 12 retrospective studies, were conducted on five continents ( Table 2). Nine studies investigated only adults [3,4,17,20,22,25,27,30,33]. The others also included children, two of them reported incidences separately for adults [6,37].…”

“…Seven studies were based on hospital discharge diagnosis of SE [3,[10][11][12]24,31,33]. The definitions of diagnostic times for establishing the diagnosis of SE ranged from 5 to 30 min [4,6,27], the definition by ILAE 2015 was used in two studies [25,30]. The annual reported crude incidences varied between 1.29 [3] and 43/100,000 adults (derived from Fig.…”

“…History of epilepsy was reported in up to 60.6% of episodes [37]; one study excluded patients with preexisting epilepsy [35]. Case fatalities at 30 days ranged from 4.6% to 39% [20,37], and in hospital from 5.0% to 24.4% [23,27].…”

“…Of note, Americans with African descent made 80% of the study population in Virginia [6], compared with 58.7% [11], 64% [10], and 96% [7] of Americans with European descent in California, USA, and Rochester, respectively [6,7,10,11]. Studies performed in Europe include mainly Caucasians [4,14,16,17,20,[22][23][24][25]27,30], and studies in Thailand and Taiwan include mainly people with Asian descent [3,31,33], although exact percentages were only rarely reported. The population on the island of LaReunion included 23% of inhabitants with European descent, 53% "ethnically mixed", and people with Indian, Chinese, and African descent [35].…”

“…A Finnish prospective study used 5 min for all forms of SE and reported a fourfold increase to previous studies [4]. Five minutes for all forms of SE were also used in a Taiwanese and a Danish population-based study [27,31]. However, focal seizures and absence seizures may last up to 10 min [45]; hence, a 5-minute criterion for all forms of SE predisposes to overestimation.…”