Short-term mortality and prognostic factors related to status epilepticus

Abstract

Epileptic seizures are self-limited, lasting, in general, less than to 2 minutes. Status epilepticus (SE) is manifested by continuous or recurrent epileptic seizures without full recovery of motor, sensory and/or cognitive functions, and has multiple etiologies and a diverse prognosis. The duration of seizures in SE varies from 5 to 30 minutes, depending on the definition 1 . It is one of the most frequent neurological emergencies, with an estimated annual incidence of from 6.2 to 61/100,000 people 2,3 . SE is associated with long-term mortality that is nearly three times greater than that of the general population 4 . Indeed, despite new advances in medical treatment, short-term mortality remains high, ranging from 3 to 40%, depending on the sampling methods, age, specific etiology, or refractoriness of SE .Several studies agree that the most important factors related to mortality in SE are older age, acute symptomatic etiology such as central nervous system (CNS) infection, acute stroke, metabolic disturbances, and anoxia, and long seizure duration. Anti-epileptic drug (AED) withdrawal in previously epileptic patients is typically associated with low mortality 2,6 . For other characteristics, such as gender, history of prior epilepsy, refractory SE, adequacy of medical treatment, presence of medical complications, level of consciousness, and electroencephalographic pattern, there is no consensus in the literature 2 . A better understanding of SE prognostic factors would assist in making treatment-related decisions. AbStrActObjective: Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method: This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results: The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions: Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications.Keywords: status epilepticus, epilepsy, mortality, prognosis. reSumo Objetivos: Status epilepticus (SE) está associado com morbidade e mortalidade importantes. Diversos estudos avaliaram determinantes de prognóstico relacionados com SE, havendo controvérsias neste sentido. O objetivo deste estudo foi avaliar mortalidade no SE e seus fatores determinantes. Método: Estudo prospectivo, em Ribeirão Preto, incluiu 105 pacientes...

The Clinical Characteristics and Prognostic Analysis of Status Epilepticus in Northeast China

“…The overall mortality rate in the US is approximately 20% [4], in Thailand it is about 11.96% [5], and in Brazil it can reach up to 36.2% [11]. Hay et al [6] performed a retrospective study of patients admitted to an intensive care unit with the primary admission diagnosis of SE in ­Australia and New Zealand, and they found that mortality decreased greatly from 2.6% in 2000 to 0.75% in 2013.…”

Hospital Mortality Among Elderly Patients Admitted With Neurological Disorders Was Not Predicted by any Particular Diagnosis in a Tertiary Medical Center

“…Neurological disorders are severely disabling and patients are often admitted to tertiary care hospitals [ 4 , 8 , 9 ]. Moreover, acute NDs such as stroke, intensive-care-unit-acquired weakness, delirium, epilepsy and epileptic seizures are associated with high hospital mortality [ 10 - 14 ]. Although the trend towards hospital death due to dementia is reversing, two of five patients with dementia died in hospitals [ 15 ].…”

Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study

“…Additionally, cases of stroke and seizures usually demand a longer LOS when compared to other ICU patients 28 . The present study population included some cases of convulsive and non-convulsive SE, which is usually an underdiagnosed condition and it is associated with longer length of stay 12,29 . In this study, both clinical types of SE were related to long LOS according to study criteria; however, after multivariate analysis, SE was not a statistically significant predictor of long LOS.…”

“…Studies of neurological disorders among elders admitted to a tertiary centre in Salvador found epilepsy in 16% of elderly inpatients, and the majority of them had a long LOS 9,10 . Notwithstanding these facts, reports of elderly inpatients admitted with epileptic seizures in Brazil are scarce 7,11,12,13,14,15,16 . The aim of the present study was to identify independent predictors of long LOS in a cohort of elderly inpatients who were admitted with epileptic seizures or experienced seizures during hospitalization.…”