Status Epilepticus after Stroke Is Associated with Increased Long‐term Case Fatality

Abstract

Summary:Purpose: The aim of this study was to determine the long-term case fatality of patients with a first episode of status epilepticus (SE group) of cerebrovascular etiology, as compared with that in acute stroke patients without SE (AS group).Methods: Patients with SE who had been prospectively admitted to an epidemiologic study were retrospectively compared with a cohort of patients from the local stroke registry. The main outcome end point was overall survival. Survival curves were generated according to the Kaplan-Meier method and compared by using the log-rank test. An extended Cox model was used to examine the impact of patient group on the risk of death. Covariates considered potential confounders included age at diagnosis, sex, type of stroke, affected hemisphere, and localization of lesions.Results: Of 166 patients who entered the study, 93 patients were in the SE group, and 73 patients were in the AS group; 53 SE patients and 35 AS patients died during the study. Patient group (SE vs. AS) showed no significant impact on survival (p = 0.0832) in univariate analysis. In contrast, the results from a multivariable analysis suggest that after 6 months, patients with SE were at about twice the risk of death as were patients with AS [hazard ratio of 2.12 with 95% confidence interval, 1.04-4.32, p = 0.0392].Conclusions: The occurrence of SE in patients with cerebrovascular disease indicates a high risk of death within 3 years. In contrast, the case fatality risk attributable to recurrent status or seizures is lower. Key Words: Long-term mortality-Case fatality-Risk factors-Causes of death-Status epilepticus.Status epilepticus (SE) is a major neurologic emergency with an incidence of ∼20/100,000 for the white population in industrialized countries. Several studies have described determinants of mortality among patients with SE (Lowenstein and Alldredge, 1998). Most of these studies have investigated mortality after SE up to a maximum follow-up period of <1 year, mostly up to 30 days or to discharge from hospital (Aminoff and Simon, 1980;Barry and Hauser, 1993;Scholtes et al., 1994;Towne et al., 1994;Logroscino et al., 1997).SE was associated with short-term mortality rates of ∼20% (Hauser, 1990;DeLorenzo et al., 1995;Logroscino et al., 1997;Lowenstein and Alldredge, 1998;Knake et al., 2001;Rosenow et al., 2002;Wu et al., 2002). Patient age at diagnosis, etiology of SE (especially anoxia), severity of the underlying disease. and duration of SE were main predictors of increased short-term mortality (Hauser, 1990;Lowenstein and Alldredge, 1998;Wu et al., 2002 In contrast, available reports examining long-term mortality after SE are sparse. Only one recent study systematically analyzed mortality at more than 10 years after the first episode of SE and found an increased long-term mortality of 43%, significantly associated with older age, status duration >24 h, acute symptomatic etiology including stroke, and myoclonic SE caused by hypoxic brain injury (Logroscino et al., 2002).The authors concluded that SE alone...

EEG Patterns and Epileptic Seizures in Acute Phase Stroke

“…We did not find an increased risk of short-term mortality in patients with PLEDs and/or early epileptic clinical manifestations, which is in contrast to the results reported in other studies [23,25,27,28,29]. The 1-week follow-up design adopted in our study may explain this difference between our results and those of previous studies, which considered mortality rates for up to 30 days after stroke [19,23,24].…”

“…Furthermore, early-onset SE is associated with a higher risk of SE recurrence and a higher mortality [22], although the impact of early seizures on mortality remains a matter of debate. Some studies have indeed found a higher mortality rate in stroke patients with early seizures, at time points ranging from 48 h to 1 year after the event, while other studies that took stroke severity into consideration failed to confirm these findings [19,23,24]. Moreover, in a recent paper, Hesdorffer et al [7] reported that acute symptomatic stroke seizures, when compared with unprovoked seizures, have a higher risk of short-term (30 days) versus long-term (10 years) mortality and a lower risk of subsequent unprovoked seizures, thus arguing against the inclusion of acute symptomatic seizures as epilepsy.…”

Inhibition of monoacylglycerol lipase terminates diazepam‐resistant status epilepticus in mice and its effects are potentiated by a ketogenic diet

“…5,6 In particular, experimental studies in multiple mammalian species have demonstrated that SE itself is sufficient to induce cell damage, neurologic comorbidities, and the development of epilepsy, 5 thereby supporting that the occurrence of prolonged unremitting seizures may contribute to pathologic outcomes in humans in addition to underlying pathologies. 7,8 The correlation between SE in preclinical models and humans provides an ideal platform for developing new treatments that can move from laboratory testing to a clinical population with high unmet need. The search for potential therapeutic targets led to the identification of molecular mechanisms underlying SE development in rodents.…”

Some clinical and diagnostic features of patients with new-onset epilepsy in the presence of chronic cerebrovascular disease

“…Цереброваскуляр-ная патология считается одним из ве-дущих факторов риска эпилепсии у больных старшей возрастной группы [5][6][7][8][9][10][11]. Диагностика эпилепсии у па-циентов позднего возраста представ-ляет определенные трудности, и не-редко заболевание выявляют спустя несколько лет после его начала.…”