Spectrum and Predictors of Refractory Status Epilepticus in a Developing Country

Dubey, Deepanshu; Bhoi, Sanjeev Kumar; Kalita, Jayantee; Misra, Usha Kant

doi:10.1017/cjn.2017.28

Cited by 9 publications

(16 citation statements)

References 37 publications

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“…In this prognostic study, the consecutive recruitment lasted for 12 years, which made it a larger database to explore the CSE predictors, compared with our previous study. The age distribution of patients in this prognostic study was closer to that in other study sample from different countries, like the USA and India 22,23 . To some extent, this overcame the disadvantage that END‐IT derived from a younger SE cohort with a median age of 25.…”

Section: Discussionsupporting

confidence: 58%

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Development and validation of a nomogram to provide individualized predictions of functional outcomes in patients with convulsive status epilepticus at 3 months: The modified END‐IT tool

Wang

Gao

et al. 2023

CNS Neurosci Ther

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AimsThe prediction of outcomes in convulsive status epilepticus (CSE) remains a constant challenge. The Encephalitis‐Nonconvulsive Status Epilepticus‐Diazepam Resistance‐Image Abnormalities‐Tracheal Intubation (END‐IT) score was a useful tool for predicting the functional outcomes of CSE patients, excluding cerebral hypoxia patients. With further understanding of CSE, and in view of the deficiencies of END‐IT itself, we consider it necessary to modify the prediction tool.MethodsThe prediction model was designed from a cohort of CSE patients from Xijing Hospital (China), between 2008 and 2020. The enrolled subjects were randomly divided into training cohort and validation cohort as a ratio of 2:1. The logistic regression analysis was performed to identify the predictors and construct the nomogram. The performance of the nomogram was assessed by calculating the concordance index, and creating calibration plots to check the consistency between the predicted probabilities of poor prognosis and the actual outcomes of CSE.ResultsThe training cohort included 131 patients and validation cohort included 66 patients. Variables included in the nomogram were age, etiology of CSE, non‐convulsive SE, mechanical ventilation, abnormal albumin level at CSE onset. The concordance index of the nomogram in the training and validation cohorts was 0.853 (95% CI, 0.787–0.920) and 0.806 (95% CI, 0.683–0.923), respectively. The calibration plots showed an adequate consistency between the reported and predicted unfavorable outcomes of patients with CSE at 3 months after discharge.ConclusionsA nomogram for predicting the individualized risks of poor functional outcomes in CSE was constructed and validated, which has been an important modification of END‐IT score.

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Section: Discussionsupporting

confidence: 58%

“…The age distribution of patients in this prognostic study was closer to that in other study sample from different countries, like the USA and India. 22,23 To some extent, this overcame the disadvantage that END-IT derived from a younger SE cohort with a median age of 25. In this study, more senile patients were enrolled.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a nomogram to provide individualized predictions of functional outcomes in patients with convulsive status epilepticus at 3 months: The modified END‐IT tool

Wang

Gao

et al. 2023

CNS Neurosci Ther

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“…Of these, 309 were included for full-text evaluation, leading to the final inclusion of 95 studies (60 case reports, 2 interventional studies, and 33 case-control/cohort studies; for references see eTable 1 and 2 in Supplement 1 and a list of excluded studies is given in eTable 3 in Supplement 1), and 30 conference abstracts (n = 1200 reported patients). The study team identified 26 studies describing cohorts with 10 or more patients (data set 1, n = 1031 patients; Figure 1) and 104 studies describing individual patient data in sufficient detail (data set 2, n = 266 patients; Figure 1). The data sets partly overlapped and 97 patients were included in both.…”

Section: Resultsmentioning

confidence: 99%

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

et al. 2023

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ImportanceSuper-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 hours or more after the onset of anesthetic therapy or recurs on the reduction/withdrawal of anesthesia. Current clinical knowledge of the disease and optimal treatment approach is sparse.ObjectiveTo systematically assess clinical characteristics, causes, outcomes, prognostic factors, and treatment approaches for patients with SRSE.Design, Setting, and ParticipantsIn this systematic review and meta-analysis, all studies reporting adult patients (18 years or older) diagnosed with nonanoxic SRSE were considered for inclusion, irrespective of study design. The databases used were MEDLINE, Cochrane Library, EMBASE, and ClinicalTrials.org (database inception through May 5, 2022).Data extraction and synthesisThe study complied with the PRISMA guidelines for reporting, data extraction, and data synthesis. Different tools were used to assess risk of bias. All available data were extracted and missing data were neither imputed nor completed by contacting the study authors.Main outcome and measuresSuccessful treatment of SRSE, in-hospital mortality, and disability at discharge (estimated modified Rankin Scale).ResultsThe study team identified a total of 95 articles and 30 conference abstracts reporting 1200 patients with nonanoxic SRSE (266 individual patients were available for meta-analysis). They had a mean SRSE duration of 36.3 days, mean age of 40.8 years, and equal sex distribution. Patients with SRSE had a distinct pattern of etiologies where acute cerebral events and unknown etiologies accounted for 41.6% and 22.3% of all etiologies, respectively. Reports of SRSE caused by, eg, alcohol, drugs, or tumors were rare. At discharge, only 26.8% had none to slight disability (none, 16 [8.4%]; nonsignificant and slight disability, 35 [18.4%]). In-hospital mortality was 24.1%. Mortality stabilized after long-term treatment (more than 28 days) but with increased rates of seizure cessation and moderate to severe disability. Established prognostic factors, such as age and etiology, were not associated with in-hospital mortality. Reported treatment with ketamine, phenobarbital, other barbiturates, vagus nerve stimulator, and ketogenic diet were not associated with outcome.Conclusion and RelevancePatients with SRSE are distinct due to their pattern of care (eg, long-term treatment to younger patients without negative prognostic factors and unknown/nonmalignant etiologies) and their natural course of SE. Very long-term treatment was associated with lower mortality and high odds of cessation of SRSE but increased risk of moderate to severe disability.

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“…This might be due to the different population age structures in developing countries compared to developed countries: An SE cohort in an Indian study had a median age of 38, 28 and another SE cohort in Brazil had a median age of 25. In addition, the functional outcomes were assessed 3 months after discharge rather than 3 months after SE onset.…”

Section: Key Pointsmentioning

confidence: 99%

“…The cohorts included in STESS, EMSE, and mSTESS had a median age over 60, but the median age of patients included in END-IT was around 25. This might be due to the different population age structures in developing countries compared to developed countries: An SE cohort in an Indian study had a median age of 38, 28 and another SE cohort in Brazil had a median age of 25. 29 Therefore, external validation using multicenter studies in different regions is still required.…”

Section: Key Pointsmentioning

confidence: 99%

Prognostic scores in status epilepticus—a critical appraisal

2018

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Currently, there are 4 published scales evaluating status epilepticus (SE) prognosis: the Status Epilepticus Severity Score (STESS), the Epidemiology-based Mortality score in Status Epilepticus (EMSE), the modified STESS (mSTESS), and the Encephalitis Nonconvulsive Status Epilepticus Diazepam Resistence Imaging Tracheal Intubation (END-IT) score. The first prognostic score published for SE, the STESS, is a simple and practical scale that evaluates patient prognosis upon admission and is used widely to predict the outcome and stratify patients. Another scale, which was developed based on large epidemiologic studies, the EMSE, is more easily adapted to different regions around the world when assessing individual risk and stratifying patients in interventional studies. The mSTESS was created by adding the modified Rankin Scale (mRS) to the STESS, which decreases the ceiling effect and increases the mortality prediction capabilities of the STESS. The END-IT is the only prognostic scale assessing functional outcome and is comprehensively simple and satisfyingly accurate. Evaluating the limitations of each of these scales aids in the exploration and advancement of SE prognostic scales, thereby facilitating better clinical interventions and scientific research.

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Spectrum and Predictors of Refractory Status Epilepticus in a Developing Country

Abstract: RSE was common (42.5%) among patients with SE in a tertiary care center in India. It was associated with high mortality and poor outcomes. Age above 60 years and metabolic aetiology were found to be predictors of poor outcomes.

Cited by 9 publications

References 37 publications

Development and validation of a nomogram to provide individualized predictions of functional outcomes in patients with convulsive status epilepticus at 3 months: The modified END‐IT tool

Development and validation of a nomogram to provide individualized predictions of functional outcomes in patients with convulsive status epilepticus at 3 months: The modified END‐IT tool

Outcomes and Treatment Approaches for Super-Refractory Status Epilepticus

Prognostic scores in status epilepticus—a critical appraisal

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