Incidence, management and short-term prognosis of status epilepticus in the emergency department: a population survey

Nazerian, Peiman; Lazzeretti, Delia; Vanni, Simone; Donnarumma, Emilia; Magazzini, Simone; Ruggiano, Germana; Giannasi, Gianfranco; Grifoni, Stefano; Zaccara, Gaetano

doi:10.1097/mej.0000000000000568

Cited by 9 publications

(17 citation statements)

References 4 publications

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“…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].…”

Section: Study Design and Core Characteristicsmentioning

confidence: 99%

“…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.…”

Section: Study Design and Core Characteristicsmentioning

confidence: 99%

“…The etiology of SE was acute symptomatic in 24.8 to 68.7% [24,30], remote symptomatic in 18.6 to 62.7% [16,17], progressive symptomatic in 3.1 to 27.3% [30,35], and 1.4 to 3.5% occurred in defined electroclinical syndromes (Table 3) [25,37]. The etiology was unknown in 1.8 to 17.7% [25,37].…”

Section: Etiologiesmentioning

confidence: 99%

“…In Rochester, elderly steadily increased to 23.1% in 1960 to further decrease to 19.8% in 1990 (Table 1) [7][8][9]. For practical reasons, we can group the studies according to their percentages of elderly in their adult population, which helps to quickly estimate the amount of people affected by SE in this high risk group: 10-20% of adults [3,7,8,31,33,35], 20-30% [5][6][7][8][10][11][12]14,16,17,37], and 30-40% [4,20,22,23,25,30]. In the next decades, a category of 40-50% will be useful due to progressive aging especially in European countries (Table 1) [4,30].…”

Section: Distribution Of Age and Ethnicity In Study Populationsmentioning

confidence: 99%

“…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].…”

Section: Distribution Of Age and Ethnicity In Study Populationsmentioning

confidence: 99%

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

Leitinger

Trinka

Zimmermann

et al. 2020

Epilepsy & Behavior

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Status epilepticus (SE) is a severe neurologic condition associated with high morbidity and mortality. Population-based studies in adults have found a wide range of incidences in various regions in the world. Although the incidence of SE increases almost exponentially in the elderly, data on census-based population statistics in these studies are scarce. This study provides a critical review with an emphasis on census-based population statistics and study characteristics in adults. Methods: We performed a systematic search of population-based studies on SE in adults in PubMed using "status epilepticus" in combination with "epidemiology", "population", and "incidence" as search terms, and also screened references. For each identified study, we assessed and extracted the respective population pyramids of study and reference population, and study characteristics. Results: We identified 22 population-based studies (eleven from Europe, six from North America, three from Asia, one from Africa, and one from Australasia). Incidence rates of patients with SE ranged from 1.29 to 73.7/100,000 adults (95% confidence interval (CI): 76.6-80.3) and of SE episodes up to 81.1/100,000 adults (95% CI: 75.8-87.0). The proportions of elderly and very old patients varied by a factor of 2.6 and 8.5, respectively, depending on study period and place. Further major reasons for heterogeneity were retrospective or prospective study design, definition of time to diagnose SE, variable detection of nonconvulsive SE (NCSE), different etiologies, inclusion of children, recurrent episodes, postanoxic patients, exclusion of patients with preexisting epilepsy or patients identified outside the emergency department, and choice of reference population for age-and gender adjustment. The most recent definition and classification of SE by the International League Against Epilepsy (ILAE) 2015 was used in two studies. Four studies (18.2%) reported incidences per ten-year age strata necessary for age adjustment to various reference populations. Conclusions: This critical review reveals a marked heterogeneity among population-based studies on SE in adults. It provides comprehensive details on census-based population statistics in study and reference populations and various study designs and characteristics essential for direct comparisons between studies. Reporting on these essential key features should be improved in population-based studies on SE.

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Section: Study Design and Core Characteristicsmentioning

confidence: 99%

Section: Study Design and Core Characteristicsmentioning

confidence: 99%

Section: Etiologiesmentioning

confidence: 99%

Section: Distribution Of Age and Ethnicity In Study Populationsmentioning

confidence: 99%

Section: Distribution Of Age and Ethnicity In Study Populationsmentioning

confidence: 99%

See 3 more Smart Citations

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

Leitinger

Trinka

Zimmermann

et al. 2020

Epilepsy & Behavior

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Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight

Pavlova

2021

Epilepsia Open

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Epilepsy (ILAE), and International Bureau for Epilepsy have called epilepsy a public health imperative, with appropriate emphasis on low-to-middle-income countries (LMIC). Although Canada is a high-income country (HIC), income is not distributed uniformly. Furthermore, epilepsy data from the national statistical agency explicitly overlook the Arctic by excluding these territories. A common neurologic emergency, status epilepticus (SE) is a life-threatening manifestation of epilepsy that demands prompt treatment to avoid death and longterm sequelae. Therefore, we examined the rate of SE in a well-defined Canadian Arctic region.Methods: This study takes epidemiologic advantage of the Kivalliq Region's geographical isolation, which is accessible only by air. All SE patients requiring emergency care are consistently flown 1200-1900 kilometers to a single designated hospital in a distinct southern part of Canada for further management and electroencephalography (EEG). We conducted a retrospective database and chart review at this "bottleneck" hospital to identify patients with seizure(s) severe enough to justify emergency airborne medical evacuation over a 11.25-year period from 2009 to 2020. Results:We screened 40 392 EEGs to yield 117 distinct medical evacuations for "operational SE" from 99 patients to derive estimated SE incidences of 99.9 evacuations per 100 000/year and 84.5 patients per 100 000/year. The average time from seizure onset to EEG was 3.2 days. Only 16.2% of SE patients had known epilepsy. For "confirmed SE" cases meeting ILAE criteria, or cases with persistently epileptiform EEG despite days of empiric treatment, estimated incidence was 77.7 evacuations per 100 000/year and 64.9 patients per 100 000/year. Significance: High SE and epilepsy rates in the Canadian Arctic are consistent with LMIC rather than HIC. Our findings demonstrate the paradox of LMICequivalent epilepsy populations camouflaged within HIC. Our findings also highlight the long-standing plight of these under-served and overlooked populations hidden in plain sight.

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Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study

Kantanen

Sairanen

Kälviäinen

2019

Epilepsy & Behavior

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Objective: The objective of this study was to determine the incidence in Eastern Finland of the different stages of status epilepticus (SE): 1) at the early stage of SE (a prolonged seizure lasting over 5 min);, 2) refractory SE (RSE), and 3) super-refractory SE (SRSE). Methods: Firstly, we conducted a retrospective study on the incidence and outcome of intensive care unit (ICU)treated RSE and SRSE in the adult population (≥16 years) in Kuopio University Hospital (KUH)'s special care responsibility area (840,000 inhabitants). Secondly, we conducted a prospective study using the International League Against Epilepsy (ILAE)'s new definition for SE (prolonged seizures lasting over 5 min), in adult (≥16 years) patients in the KUH municipality district (North Savo, 248,000 inhabitants). Results: The retrospective study on ICU-treated RSE and SRSE from 2010 to 2012 identified 75 patients with RSE, of whom 21% were treated as SRSE, resulting in an annual age-adjusted incidence of ICU-treated RSE of 3.0/100,000 (95% confidence interval [CI]: 2.4-3.8) and 0.6/100,000 (95% CI: 0.4-1.0) for SRSE. In the prospective study of early stage SE (seizures lasting over 5 min), we identified 151 consecutive episodes during the 9-month study period in 2015, corresponding to an annual age-adjusted incidence of 81.1/100,000 (95% CI: 75.8-87.0). In this study, 11 seizure episodes became refractory, resulting in an age-adjusted incidence of RSE of 6.0/100,000 (95% CI: 3.4-10.4), of which seven were treated in the ICU [3.8/100,000 (95% CI: 1.8-7.8)], four were treated palliatively [2.2/100,000 (95% CI: 0.82-5.7)], and two evolved to SRSE [1.1/100,000 (95% CI: 0.3-4.3)]. Conclusions:The new ILAE 2015 definition of SE resulted in a four-fold increase in incidence of SE compared to the earlier 30-min definition reported earlier in Europe. In the epidemiology of RSE, the incidence of ICU-treated RSE, palliatively treated RSE, and SRSE needs to be separated.

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Incidence, management and short-term prognosis of status epilepticus in the emergency department: a population survey

Cited by 9 publications

References 4 publications

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

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

Status epilepticus in the Canadian Arctic: A public health imperative hidden in plain sight

Incidence of the different stages of status epilepticus in Eastern Finland: A population-based study

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