Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation

Abstract

Background Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers. Methods In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women. Results Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004). Conclusions This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.

Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India

“…The cutoff of age with poor outcomes in our study was 36 years; however, the association was not significant [ 2 , 3 , 11 - 14 ]. While some studies have shown female gender being associated with unfavourable outcomes, the gender of our study patients did not show any significant correlation, although male patients were more in number than female patients [ 15 , 16 ].…”

Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study

“…There is a growing body of evidence that critically ill women experience worse outcomes, especially after OHCA, even after adjusting for age and cardiac arrest circumstances 5 , 64 , 65 . Sex and/or gender differences in resource allocation, such as admission to intensive care, provision of coronary artery bypass grafting, mechanical ventilation, and targeted temperature management, were also observed in other critical care populations and might partially explain the observed differences 66 – 68 .…”

Emergent Management of Status Epilepticus

“…Differences in sex can affect disease presentation, symptom severity, drug metabolism, and response to treatment. A 2023 study examined sex disparities in a retrospective analysis of 762 cases of status epilepticus from two Swiss tertiary care centers revealed that women were more prone to focal nonconvulsive status epilepticus without coma, whereas men were more likely to experience status epilepticus with motor symptoms 79 . Moreover, the study investigated factors related to outcomes and found that women were less likely to be discharged home and more likely to be discharged to nursing homes or hospices.…”