Short‐Term Mortality After a First Episode of Status Epilepticus

Abstract

Summary:Purpose: Studies evaluating short-term mortality among people who experience status epilepticus (SE) have produced conflicting results. Most studies are derived from clinical series with results affected by unspecified follow-up period and select referral of cases. This study was planned to evaluate short-term mortality after a first episode of SE.Methods: We performed a population-based retrospective cohort study to determine the short-term mortality following a first episode of SE. Between January 1,1965 and December 3 1, 1984, we studied all first episodes of afebrile SE who received medical attention in Rochester, Minnesota. Cases were followed until death or end of the study (February 1996).Results: Mortality within the first 30 days was 19% (38 deaths out of 201 incident SE). Thirty-four deaths (89%) occurred among those with nonfebrile acute symptomatic SE, while 4 deaths (11%) occurred among those with unprovoked SE. Within the acute symptomatic group, after adjusting for age, there was a decreased risk of death in women (RR = 0.4; 95% CI: 0.2-0.9). No effect of duration or seizure type was shown after adjusting for other risk factors.Conclusions: One out of 5 subjects with SE died within the first 30 days. Short-term mortality is associated with the presence of an underlying acute etiology. Among acute symptomatic cases, women had a decreased risk of dying. Key Words: Status epilepticus-Mortality-Prognosis-EpilepsyEpidemiology.Several studies have described determinants of mortality among patients with status epilepticus (SE) (1-10). The majority have focused on short-term prognosis with a follow-up period frequently unspecified but generally <1 year. Despite improved treatment over the past 20 years, these studies describe SE as a medical emergency characterized by a poor prognosis and high mortality.Published mortality among patients with SE varies from 11% (1) to 34% (3). The wide range is determined by different distributions of causes and age across studies. Most reports are based on hospital series. The one population-based study of mortality associated with SE, conducted in Richmond, Virginia, reported a 30-day case fatality of 22% (4). Interpretation of SE mortality is limited if a clear distinction is not made between unprovoked SE and SE associated with concurrent systemic or organic brain disease (3,4). The prognosis of SE among patients with epilepsy has been suggested to be more favorable when

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

“…Confirming prior studies of SE, we found mortality to be associated with older age (54,55), etiology (54)(55)(56)(57)(58)(59), seizure duration (55,57), and APACHE-2 scores (7).…”

Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

“…Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al, 1994;Towne et al, 1994;Logroscino et al, 1997).…”

“…To exclude etiology as an established predictor of short-term and long-term case fatality (Oxbury and Whitty, 1971;Scholtes et al, 1994;Towne et al, 1994;DeLorenzo et al, 1995;Logroscino et al, 1997;Logroscino et al, 2002), patients with SE of cerebrovascular origin were compared with patients with acute stroke, but without seizures. The main result of this study is that patients with the first episode of SE of vascular etiology have a significantly FIG.…”

“…Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al, 1994;Towne et al, 1994;Logroscino et al, 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al, 1995;Logroscino et al, 1997;Lowenstein and Alldredge, 1998;Knake et al, 2001;Rosenow et al, 2002;Wu et al, 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease.…”

“…SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al, 1995;Logroscino et al, 1997;Lowenstein and Alldredge, 1998;Knake et al, 2001;Rosenow et al, 2002;Wu et al, 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease.…”