Epidemiology of status epilepticus in adults: A population‐based study on incidence, causes, and outcomes

Abstract

Objective: In 2015, the International League Against Epilepsy (ILAE) proposed a new definition of status epilepticus (SE): 5 minutes of ongoing seizure activity to diagnose convulsive SE (CSE, ie, bilateral tonic-clonic SE) and 10 minutes for focal SE and absence SE, rather than the earlier criterion of 30 minutes. Based on semiology, several types of SE with prominent motor phenomena at any time (including CSE) were distinguished from those without (ie, nonconvulsive SE, NCSE). We present the first population-based incidence study applying the new 2015 ILAE definition and classification of SE and report the impact of the evolution of semiology and level of consciousness (LOC) on outcome. Methods: We conducted a retrospective population-based incidence study of all adult patients with SE residing in the city of Salzburg between January 2011 and December 2015. Patients with hypoxic encephalopathy were excluded. SE was defined and classified according to the ILAE 2015. Results: We identified 221 patients with a median age of 69 years (range 20-99 years). The age-and sex-adjusted incidence of a first episode of SE, NCSE, and SE with prominent motor phenomena (including CSE) was 36.1 (95% confidence interval [CI] 26.2-48.5), 12.1 (95% CI 6.8-20.0), and 24.0 (95% CI 16.0-34.5; including CSE 15.8 [95% CI 9.4-24.8]) per 100 000 adults per year, respectively.None of the patients whose SE ended with or consisted of only bilateral tonic-clonic activity died. In all other clinical presentations, case fatality was lower in awake patients (8.2%) compared with patients with impaired consciousness (33%). Significance: This first population-based study using the ILAE 2015 definition and classification of SE found an increase of incidence of 10% compared to previous definitions. We also provide epidemiologic evidence that different patterns of status evolution and LOCs have strong prognostic implications.Leitinger and Trinka joint first authors ---

Burden and epidemiology of status epilepticus in infants, children, and adolescents: A population‐based study on German health insurance data

“…Therefore, we cannot provide any detailed information on the exact definition of duration of SE or febrile seizures used in each case. A recent study on the epidemiology of SE using the 2015 definition in adults found an increase of incidence of 10% compared to previous definitions . In children, febrile SE presents a concatenation of febrile seizure and SE.…”

“…A recent study on the epidemiology of SE using the 2015 definition in adults found an increase of incidence of 10% compared to previous definitions. 47 In children, febrile SE presents a concatenation of febrile seizure and SE. In the FEBSTAT study, the duration of febrile SE started at 30 minutes, with 41% of the children having SE for 30-59 minutes, 25% for 60-89 minutes, 11% for 90-119 minutes, 21% 120-239 minutes, and 3.5% for 240 minutes or longer.…”

Status epilepticus in Auckland, New Zealand: Incidence, etiology, and outcomes

“…The incidence and causes in different populations and at different ages vary greatly, as do morbidity and mortality. The reported population incidence has ranged from 8.5 up to 61/100 000/year …”

“…The reported population incidence has ranged from 8.5 up to 61/100 000/year. [2][3][4][5][6][7][8][9][10] In 2015, the International League Against Epilepsy (ILAE) proposed a new classification of SE. 11 The panel proposed a conceptual definition of SE with two operational dimensions: the time point (t1) beyond which the seizure should be regarded as "continuous seizure activity" and t2, the time of ongoing seizure activity after which there is a risk of long-term consequences.…”

Avoiding anaesthetics after multiple failed drug‐induced comas: an unorthodox approach to management of new‐onset refractory status epilepticus (NORSE)

“…Once third-line treatment with IV anaesthetics is initiated and failed, as it was in this patient, it is quite difficult and unorthodox to change the course and try to avoid IV anaesthetics, as this would mean the patient would be allowed to have seizures. Over New-onset refractory status epilepticus the years, there has been an increasing number of reports showing more favourable outcomes in patients who were awake or had focal SE at presentation (Leitinger et al, 2019). There has also been an increase in the number of reports showing radiological markers for neuronal injury during status epilepticus (Parmar et al, 2006;Cartagena et al, 2014;Mendes and Sampaio, 2016).…”