Long‐term outcomes of status epilepticus: A critical assessment

Sculier, Claudine; Gaínza‐Lein, Marina; Fernández, Iván Sánchez; Loddenkemper, Tobias

doi:10.1111/epi.14515

Cited by 100 publications

(108 citation statements)

References 94 publications

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“…Our study identified a significant increase in short‐term mortality with increasing SE duration, a finding in line with those of prior studies . A recent review of 37 studies regarding long‐term outcome of patients surviving SE revealed that the long‐term effect of SE duration on outcome is often difficult to distinguish from the underlying cause of SE . In our cohort, the RR for death of 1.06 with every additional day in SE equals an increase in risk of death of 6% per 24 hours.…”

Section: Discussionsupporting

confidence: 91%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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Objectives: Early identification of patients who are at risk of prolonged status epilepticus (SE) and patients with high chances of full recovery despite prolonged SE may urge clinicians to intensify treatment rather than to withdraw care. We aimed to develop prediction models based on readily available clinical parameters to predict prolonged SE at seizure onset and to identify patients with high chances for full recovery. Methods: From 2005 to 2016, all adult SE patients treated at the University Hospital Basel, a Swiss medical care center, were included. Multivariable Poisson regression was performed to identify predictors of prolonged SE (defined as SE for >12, >24, and >48 hours) and return to baseline from prolonged SE. The area under the receiver-operating characteristic curves (AUROC) for prediction models was calculated. Results: Of 467 patients, the median age was 66.7 years and mortality was 12%.Relative risk (RR) for death was 1.06 (P < 0.0001) with every SE day. In multivariable analysis, nonconvulsive SE with coma, SE severity score ≥3, and acute brain lesions at SE onset independently predicted prolonged SE with an AUROC of 0.68 for >12, 0.67 for >24, and 0.72 for >48 hours of SE. Absence of nonconvulsive SE with coma and a decreasing Charlson comorbidity index were independent predictors for return to baseline in prolonged SE with an AUROC of 0.82 and 0.76 following cross-validation. Both associations remained significant despite adjustments for determinants of adverse outcome, such as anesthetics and vasopressors (nonconvulsive SE with coma RR = 0.24, 95% confidence interval [CI] 0.07-0.86; comorbidity index RR = 0.87, 95% CI 0.76-0.99). Significance: Although our data indicate that identification of prolonged SE at seizure onset is unreliable, timely recognition of patients with high chances of good outcome despite prolonged SE is promising on the basis of comorbidities, type of SE, and level of consciousness. Further external validation of this prediction model is needed.

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Section: Discussionsupporting

confidence: 91%

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

et al. 2018

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“…20 Long-term outcome after SE is still challenging, and studies in this context are difficult to compare because of the heterogeneity of their design. 21 Our study provides a first and promising result regarding the predictive value of illness severity scoring systems in ICUs in this context. However, mortality after 30 days could not be assessed in this observational cohort.…”

Section: Discussionmentioning

confidence: 79%

“…Data regarding the prediction of long‐term outcome and quality of life after SE are scarce, but complete long‐term recovery from SE is possible . Long‐term outcome after SE is still challenging, and studies in this context are difficult to compare because of the heterogeneity of their design . Our study provides a first and promising result regarding the predictive value of illness severity scoring systems in ICUs in this context.…”

Section: Discussionmentioning

confidence: 84%

Illness severity scoring in status epilepticus—When STESS meets APACHE II, SAPS II, and SOFA

et al. 2018

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Summary Objective To characterize a critically ill cohort with status epilepticus (SE) by the illness severity scoring systems SAPS II (Simplified Acute Physiology Score II), APACHE II (Acute Physiology and Chronic Health Evaluation II), and SOFA (Sequential Organ Failure Assessment), and to compare their performance with the STESS (Status Epilepticus Severity Score) for outcome prediction. Methods The prospective cohort study was carried out at the University Hospital Basel, a Swiss tertiary academic medical care center. Consecutive adult SE patients hospitalized in the intensive care units from 2011 to 2016 were included. Illness severity scores and additional clinical data were recorded. Logistic regression models using automated variable selection were applied to identify scores associated with no return to functional and neurological baseline and death. Measures of discrimination and calibration were assessed. Results Among 184 patients, 33% returned to baseline. Median scores of the illness severity scores were within the lowest third of the possible scoring ranges, and all differed significantly between patients with and without return to baseline. The areas under the receiver operating curves for the prediction of no return to baseline and death ranged from 0.64 to 0.73, with the highest value for the STESS predicting no return to baseline. Measures of calibration revealed adequate model fit for all analyses. Among integral components of the scoring systems, only the Glasgow Coma Scale (GCS) differed significantly between patients with and without return to baseline. In multivariable analyses, decreasing GCS and increasing STESS had the strongest associations (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.77‐0.93 and OR = 1.34, 95% CI = 1.05‐1.68, respectively) with no return to baseline independent of all other scoring systems, whereas the APACHE II revealed the strongest association with death (OR = 1.15, 95% CI = 1.06‐1.25). Significance Although complex illness severity scoring systems in SE patients facilitate benchmarking and comparisons with other severely ill patient cohorts, they offer no advantages over the STESS and GCS regarding prediction of no return to baseline.

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“…Status epilepticus (SE), as an extreme form of epileptic seizures, can prolong for a sufficient length of time and produce irreversible insult to the brain (Trinka et al, 2015). Long-term sequelae of SE could ultimately devastate patients' quality of life and impose an overwhelming social and economic burden (Sculier et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Time-Dependent Impairment of Fear Conditioning and Associated Brain Regions After Pilocarpine-Induced Status Epilepticus

Qiu

Kinoshita

Peng

et al. 2020

Front. Behav. Neurosci.

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Our study aimed to demonstrate time-dependent declarative memory changes and its associated brain regions after status epilepticus (SE) using structural imaging techniques and machine learning methods. Pilocarpine was administrated to establish the SE model. At four different time points after SE (1, 2, 3, and 4 months, respectively), rats were subjected to structural imaging acquisition as well as contextual fear conditioning for the measurement of brain structural changes and declarative memory. Voxelbased morphometry (VBM) analysis were performed. Those significantly different regions were selected as features for training support vector machine (SVM). A linear kernel was chosen for regression of declarative memory. Leave-one-out cross-validation was applied to ensure generalization. Our results showed that the pilocarpine groups displayed the most severely impaired declarative memory at 2 months after SE and improved afterward, but failed to recover to the normal condition at 4 months after SE. The pilocarpine groups showed lower gray matter volumes and larger cerebrospinal fluid (CSF) volumes. After controlling for the total brain volumes, ANOVA demonstrated gray matter volume changes in the CA1 subfield of the hippocampus, primary somatosensory cortex, entorhinal cortex, etc. The combination of VBM and SVM identifies the somatosensory cortex and entorhinal cortex as the correlated brain regions for declarative memory dysfunctions after SE. Our study indicates that compensational mechanisms might be triggered to help with the recovery of memory functions after SE. Structural changes of the somatosensory cortex and entorhinal cortex might be involved in memory impairment after SE.

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Long‐term outcomes of status epilepticus: A critical assessment

Cited by 100 publications

References 94 publications

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Prolonged status epilepticus: Early recognition and prediction of full recovery in a 12‐year cohort

Illness severity scoring in status epilepticus—When STESS meets APACHE II, SAPS II, and SOFA

Time-Dependent Impairment of Fear Conditioning and Associated Brain Regions After Pilocarpine-Induced Status Epilepticus

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