Status epilepticus: Our experience in a tertiary care centre in Northwestern India

Abstract

Introduction:Status epilepticus (SE) is a medical emergency. Aim of this study was to examine the etiology and outcome of adult patients in status epilepticus presenting to our center.Patients and Methods:A prospective study was conducted from January 2009 to December 2010. Newly diagnosed patients as well as known case of seizure disorder presenting with status epilepticus were included. Detailed history, clinical examination, baseline investigation, neuroimaging electroencephalogram findings were recorded. Patients were treated using a standard protocol and were followed-up for 2 weeks after discharge. Quantification of precipitating factors was done using proportion, mean and standard deviation.Results:80 consecutive patients were studied. Mean age was 38.43 ± 16.56 years (range 13 to 78 years). Male to female ratio was 4:1. 57.5% were known cases of seizure disorders. Generalized tonic-clonic seizure was commonest presentation in 91.30%. Majority (97.5%) had convulsive SE. Poor drug compliance was found to be the commonest precipitant (50% patients), followed by central nervous system infection (20% patients. Alcohol intake contributed in 12.5% cases, whereas, precipitating factor couldn't be traced in 7.5% patients'. In 55% patients, SE was controlled with no recurrence or complication and in 25% there was recurrence after control of SE. 15% patients ended up with persistent sequel (cognitive and psychosomatic dysfunction, neurological deficit etc.) lasting for 2 weeks or more. The mortality was 5%.Conclusion:Poor compliance with drugs (in established cases of seizure disorders) and central nervous systems infections/structural lesions (in new onset cases) were commonest causes of SE in our study group. Conventional first line antiepileptics were able to control seizures in only 55% patients.

Determinants of outcome in convulsive status epilepticus in adults: An ambispective study from central India

“…[9] In contrast, the low fatality rates of 5% as reported by Bhalla et al . [6] could be explained by the inclusion of higher percentage of patients of SE related to alcohol and drug default known to have better outcome. [26] Our patients with CSE related to drug default and alcohol had lowest incidences of unfavorable outcomes, a finding in line with Towne et al .…”

“…[4] Recent investigators from India have found the mortality in SE in the range from 5% to 29.3%. [567] Improved management strategies and availability of better antiepileptic medications might underlie the change in the outcome of SE.…”

Estado epiléptico en adultos: caracterización de pacientes monitorizados por videoelectroencefalograma

“…21 En cuanto al STESS se evidenció en nuestro estudio que el 80% (n=12) de los pacientes que obtuvieron un puntaje favorable y no fallecieron durante su estancia hospitalaria, como lo fue en el estudio inicial de Rosseti y col. 14 Al correlacionar con la mortalidad encontramos que 34,87% (n=14) fallecieron con diagnóstico de EE, cifra que se encuentra entre los parámetros descritos en la literatura mundial. Llama la atención que uno de los hallazgos que más relevancia tuvo, fue la presentación de infección de SNC en los estudios imagenológicos y que al momento de revisar la literatura encontramos una publicación similar en la India 22 , lo cual nos hace considerar la hipótesis de si en poblaciones en vía de desarrollo la infección del SNC será la causa aguda más frecuente de EE, a diferencia de lo publicado en la literatura mundial en donde se reporta la injuria isquémica cerebral. 9…”