Convulsive Status Epilepticus in a Cohort of Patients from a Peruvian Academic Hospital

Abstract

Background and Purpose: Status epilepticus is a neurologic emergency whose epidemiology, etiology and management are scarcely known in developing countries. Our objective was to describe the demographic and clinical features as well as the management of generalized convulsive status epilepticus (GCSE) in adult patients admitted to the emergency department of an academic hospital in Peru, between March 2019 and March 2020.Methods: Observational study of a prospective cohort in which patients were assessed by the emergency and neurology department on the first day of hospitalization, at discharge and at 30 days post-discharge in a follow-up visit. Relevant demographics and clinical data were collected. After being encoded and sorted, univariate statistical analysis was carried out.Results: Of the sample of 59 patients, 62.7% were males, 57.6% were unemployed, 89.8% did not finish high school, and 55.9% had intermittent GCSE with no seizure at arrival. The total calculated median times were: 60 minutes from GCSE onset to hospital arrival, 110 minutes from GCSE onset to 1st line therapy, and 7 minutes from hospital arrival to 1st line therapy. The most frequently used antiepileptic drugs were one dose of benzodiazepine (41.7%), phenytoin (76.9%), and additional doses of benzodiazepines (60%) for 1st, 2nd, and 3rd line therapies, respectively. The most frequent etiologies were antiepileptic drug suspension (27.1%), undetermined (25.4%) and acute stroke (11.8%). 62.71% had 0-2 modified Rankin score at discharge.Conclusions: In this cohort of patients, GCSE was mainly intermittent. Management times differed from the guidelines’ recommendations.

A review of neurological health disparities in Peru

“…In previous Peruvian studies that examined seizure etiologies, the most commonly reported causes were suspension of antiseizure drugs (ASDs), alcohol use, central nervous system (CNS) infections, and traumatic brain injuries ( 105 , 106 ). In those same studies, a significant number of seizures remained without a determined etiology ( 105 , 106 ), potentially highlighting disparities in access to needed diagnostic tools in the country.…”

“…In previous Peruvian studies that examined seizure etiologies, the most commonly reported causes were suspension of antiseizure drugs (ASDs), alcohol use, central nervous system (CNS) infections, and traumatic brain injuries ( 105 , 106 ). In those same studies, a significant number of seizures remained without a determined etiology ( 105 , 106 ), potentially highlighting disparities in access to needed diagnostic tools in the country. Regarding the frequency of epilepsy in Peru, a study that investigated the disease in rural Peruvian communities revealed that 10.8 out of every 1,000 individuals had active epilepsy, meaning these patients’ seizures were not well-controlled ( 107 ).…”

“…In another study that prospectively followed patients that were admitted to a referral center in Lima with generalized convulsive status epilepticus, a life-threatening manifestation of seizures, only 56.6% of ASDs were administered at their recommended doses ( 105 ). In that same study, it was also noted that none of the enrolled participants received an initial electroencephalogram (EEG) for diagnostic evaluation of their seizures ( 105 ), even though such instruments are typically the standard of care when managing patients with seizures ( 110 ). These disparities in both ASD and EEG availability underscore a need to address the health access barriers that many Peruvians face regarding seizure management.…”