Long‐term outcome of convulsive status epilepticus: a 10‐year follow‐up

Abstract

Objective. This study aimed to determine the mortality, causes of death and factors affecting the outcome of convulsive status epilepticus (CSE) at 10 years. Method. This retrospective study consisted of 62 consecutive adult patients diagnosed with CSE at the Helsinki University Hospital (HUS) emergency department during 2002‐2003. Patients were followed for up to 10 years or up to the time of death. Data on patient demographics, CSE characteristics, treatment, complications, and outcome from the time of CSE were collected. The Official Statistics of Finland provided the information on mortality and causes of death. Survival analysis was conducted using Cox proportional hazards regression analysis. Results. In‐hospital mortality was 8.1%, and mortality was 25.8% at one year, 51.6% at five years and 64.5% at 10 years. Estimated standardized mortality ratio (SMR) was 5.3 and the deceased patients lost 20.9 potential years of life, on average. The leading causes of death were disorders of the brain or the circulatory system, epilepsy‐related conditions or intracranial tumours. The univariable survival analysis demonstrated that age ≥65 (HR=2.8, p=0.001), Charlson Comorbidity Index (CCI)>0 (CCI=1‐3: HR=3.0, p=0.009; CCI>3: HR=8.4, p<0.001), Status Epilepticus Severity Score (STESS)>4 (HR=5.3, p<0.001) and Epidemiology‐Based Mortality Score (EMSE‐EAC)>15 (HR=2.2, p=0.036) were risk factors and a Glasgow outcome scale (GOS) of 5 at discharge (HR=0.14, p=0.025) was a protective factor for survival. The multivariable analysis established STESS>4 (HR=5.0, p=0.002) and CCI>0 (CCI=1‐3: HR=2.9, p=0.015; CCI>3: HR=6.3, p=0.006) as independent risk factors and GOS>3 (time‐dependent) (GOS=4: HR=0.33, p=0.048; GOS=5: HR=0.13, p=0.019) as a protective factor for survival. Significance. The rate of long‐term mortality and number of potential years of life lost were high. Factors demonstrative of the overall situation of the patients, such as comorbidities, functional state after CSE and age, were significant predictors for long‐term outcome.

Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM e-Survey)

“… 3 , 5 , 17 Prolonged seizures can lead to irreversible neuronal damage; short- and long-term neurological, cognitive, and behavioral impairments; and poor quality of life. 1 , 2 Two important factors which determine the timing of initiation of treatment are the duration of seizure activity which makes it unlikely to self-terminate and, therefore, requires treatment; and the duration of seizure after which neurological harm becomes significant if seizures continue. Seizures lasting for >5 minutes tend to become prolonged and need treatment for termination.…”

“…introduction Pediatric status epilepticus (PSE) is a common neurological emergency associated with significant mortality and neuromorbidity such as cognitive impairment and focal neurological deficits. 1,2 Goal of management of PSE is to stop seizure activity as quickly as possible to prevent neuronal injury, mortality, and to minimize short-and long-term neuro-morbidity. 3,4 Management of PSE is a step-wise approach with first-line antiseizure medications (ASMs) typically benzodiazepines such as midazolam, lorazepam, or diazepam; followed by second-line ASMs including phenytoin/fosphenytoin, levetiracetam, or valproate.…”

“…Pediatric status epilepticus (PSE) is a common neurological emergency associated with significant mortality and neuro-morbidity such as cognitive impairment and focal neurological deficits. 1 , 2 Goal of management of PSE is to stop seizure activity as quickly as possible to prevent neuronal injury, mortality, and to minimize short- and long-term neuro-morbidity. 3 , 4 …”