Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation

Abstract

Background: Identification of outcome-predictive factors could lower risk of under-or over-treatment in status epilepticus (SE). Older age and acute symptomatic aetiology have been shown to predict mortality, but other variables are controversial and level of consciousness has received relatively little attention. The objective of this study was to assess variables predictive of mortality, particularly those available at presentation. Methods: The discharge database (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) of two university hospitals was screened for adult patients with EEG confirmed SE, excluding cerebral anoxia. Outcome at discharge (mortality, return to baseline clinical conditions) was analysed in relation to demographics, clinical features, and aetiology. Aetiologies were also classified based on whether or not they were potentially fatal independently of SE. Results: Mortality was 15.6% among 96 patients with a first SE episode, 10 of whom also experienced recurrent SE during the study period. Eleven other patients had only recurrent SE. Mortality was 4.8% among these 21 patients with recurrent SE. Return to baseline condition was more frequent after recurrent than incident SE (p = 0.02). For the first SE episode, death was associated with potentially fatal aetiology (p = 0.01), age >65 (p = 0.02), and stupor or coma at presentation (p = 0.04), but not with gender, history of epilepsy, SE type, or time to treatment >1 h. Conclusions: At initial evaluation, older age and marked impairment of consciousness are predictive of death. Surviving a first SE episode could lower the mortality and morbidity of subsequent episodes, suggesting that underlying aetiology, rather than SE per se, is the major determinant of outcome.

Antibody-Mediated Status Epilepticus: A Retrospective Multicenter Survey

“…a pathology that is per se related to a poorer prognosis. However, several other papers underscore that age and etiology are the most important independent outcome predictors in SE [16]. It remains to be shown in further studies whether age will emerge as an independent risk factor in AB-SE or if other factors, such as less aggressive therapy in older patients, determine this unfavorable outcome.…”

Pathophysiology of status epilepticus

“…Status epilepticus, importantly, can be caused by a range of etiologies ( Fig. 1) [14], and etiology is often the main determinant of prognosis [18]. Here, I will consider three clinically relevant aspects to the pathophysiology of status epilepticus: why seizures persist, how prolonged seizures become drug resistant and lastly the mechanisms underlying neuronal death and those that may eventually drive cognitive decline and the increased risk of epilepsy.…”

Untitled

“…Çocuklarda bu oran daha düşük iken, yaşlılarda daha yük-sektir. [100][101][102][103] NKSE, mortalitesi değişik çalışmalarda %18-52 arasında değişmektedir. Ek hastalığı olanlarda, yoğun bakımda izlenenlerde ve tanısı gecikenlerde bu oran artmaktadır.…”