Mortality after a First Episode of Status Epilepticus in the United States and Europe

Abstract

Summary:Objective: In the last decade several studies have been published on incidence, etiology, and prognosis of status epilepticus (SE) with population-based data from the United States and Europe. The aim of this review is to summarize the available information on the epidemiology of SE and to outline the sources of the variability in reported mortality after SE.Methods: Comparison of mortality studies in SE from the United States and Europe.Results: The incidence of SE is lower in Europe (9.9-15.8/10,000) than in the United States (18.3-41/100,000). The overall mortality after SE is similar in the two U.S. studies: the case fatality is 21% in Rochester, and 22% in Richmond. All European studies excluded SE after anoxic encephalopathy following cardiac arrest. This exclusion may partly explain the lower case fatality (around 10%) found in two of the European studies. The study from Bologna showed the highest case fatality (33%) even after exclusion of anoxic encephalopathy. The mortality in acute symptomatic SE was higher than for other forms of SE across all studies.Conclusions: Short-term mortality after SE occurs mainly in the acute symptomatic group. Based on published data, it is not clear if differences in early management and medical treatment have any impact on prognosis or whether the differences can be attributed only to differences in distribution of the underlying causes in acute symptomatic SE. Future studies should address this issue. Key Words: Status epilepticus-MortalityPrognosis.Status epilepticus (SE), usually defined as a seizure lasting at least 30 min, is considered a medical emergency. It occurs most frequently in the context of an acute systemic or neurological insult and less frequently in patients with epilepsy.There have been many published studies regarding mortality after SE, most of which are based on clinical series from tertiary care centers. The reported mortality varies from 7% to 46% (1-15).Part of the variability in reported mortality after SE is dependant upon methodological issues. (1) In most studies the measure of mortality is case fatality (CF), the proportion of subjects dying in the cohort. The CF of different studies can be compared if the length of follow-up is the same. Most clinical series follow the patient through the hospital stay without specifying the number of days of follow-up, making comparison of CF across studies difAddress correspondence and reprint requests to Dr. Giancarlo Logroscino at Harvard School of Public Health, Kresge Bldg. 819, 677 Huntington Avenue, Boston, MA 02115, U.S.A. E-mail: glogrosc@hsph. harvard.eduThe commission wishes to acknowledge the support of UCB Pharma for logistical support in the organization of this workshop. ficult. (2) Multivariate techniques have been used only in the most recent studies to control for possible confounders such as age, gender, and underlying cause. (3) The consequences of SE have been compared by Sholtes et al. and differences in outcome are seen, according to the setting in which cases are identifie...

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