Outcome predictors for status epilepticus—what really counts

Abstract

In adult patients with status epilepticus (SE)-a life-threatening state of ongoing or repetitive seizures--the current evidence regarding outcome prediction is based on clinical, biochemical and EEG determinants. These predictors of outcome involve clinical features such as age, history of prior seizures or epilepsy, SE aetiology, level of consciousness, and seizure type at SE onset. The clinical risk-benefit calculation between the danger of undertreated persistent seizure activity and, conversely, the potential damage from unwarranted aggressive treatments remains a constant challenge. Improved knowledge of outcome determinants, as well as increased availability of reliable outcome prediction models early in the course of SE, is paramount for optimization of treatment of patients who develop this disorder. In this Review, we discuss the major prognostic determinants of outcome in SE. Through consideration of studies that provide measures of association between predictors of SE outcome and death, we propose a detailed--but as yet unvalidated--paradigm for assessment of these predictors during the course of SE. Such an algorithm could guide the organization of results from existing trials and provide direction with regard to the parameters that should be monitored in future studies of SE.

Long‐term outcomes of status epilepticus: A critical assessment

“…There is an urgent need for large prospective and multicenter studies, adjusted for confounders and stratified by seizure type, etiology, treatment timing, and age to account for SE heterogeneity, using validated outcome measures, responsive to the intervention. For example, safety studies comparing midazolam, propofol, and barbiturates could be considered, also taking into the account the impact of adverse events caused by prolonged deep sedation88 and considering electroencephalographic endpoint and duration of anesthetic treatments, such as seizure suppression or burst suppression, and related long‐term outcomes. Neuroprotective approaches are likely to improve outcome of patients with acute symptomatic causes, which seems to be one of the most important risk factors 20.…”

Predicting outcome of status epilepticus

“…While interpreting results, it is important to ask whether one particular factor, such as duration of SE, or the combination of many factors (i.e., EMSE-score, [6]) is or is not the survival limiting process (SLP). In other words, it depends on the investigated study population whether a particular parameter is responsible for death, or just contributes to nonsurvival among other factors, or does not play any life-limiting role at all [2].…”

“…Mortality rates for convulsive SE vary from 7.6% to 39% in population-based studies [1]. Many risk factors for death were reported as statistically significant group effects (for comprehensive review see [2]). However, group effects do not necessarily predict individual outcomes, which are needed in clinical practice.…”

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application

“…The latter has been addressed in several population-based [2,3] and hospital-based [7,8,14] studies, and oscillates between 7 and 39%, while long-term mortality at 10 years appears to be increased by a factor of 3 as compared with controls in the general population [24]. The three most important mortality predictors are an acute or potentially fatal etiology (odds ratio [OR]: 6.0), increasing age (OR: 5.5 if >65 years) and a generalized convulsive or comatose SE presentation (OR: 5.8) [25]. The risk of an unfavorable functional outcome seems to correlate with the length of ICU treatment [26], as well as, again, age and etiology [8].…”