New onset status epilepticus and its long-term outcome: A cohort study

IF 2 4区医学 Q3 CLINICAL NEUROLOGY

Epilepsy Research Pub Date : 2024-08-22 DOI:10.1016/j.eplepsyres.2024.107442

Sharath Adiga , Ravindranadh Chowdary Mundlamuri , Ajay Asranna , Lakshminarayanapuram Gopal Vishwanathan , Kenchaiah Raghavendra , Nandakumar Dalavaikodihalli Nanjaiah , PV Prathyusah , Karthik Kulanthaivelu , Sanjib Sinha

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引用次数: 0

Abstract

Purpose

New onset status epilepticus (NOSE), a subtype of status epilepticus, is a neurological emergency associated with significant morbidity and mortality. This study aimed to analyze the phenotypic spectrum and outcomes of patients presenting with NOSE.

Methods

This prospective and retrospective descriptive study included patients presenting with NOSE over a 10-year period. Data collected included patient demographics, phenotypic characteristics of SE and its etiology, Status Epilepticus Severity Score (STESS), SE classification Axis-II, and Modified Rankin Scale (mRS) scores at admission and discharge. Functional outcomes and seizure status were assessed at least 6 months post-discharge. Prognostic factors for mortality and the development of epilepsy were also analyzed.

Results

A total of 208 patients were included, with a mean age of 41.97 ± 21.66 years, and a male predominance (57.1 %). Focal to bilateral tonic-clonic seizures were observed in 47.5 % of patients. The etiology was acute symptomatic in 35.57 % and remote symptomatic in 24 %. The median hospital stay was 4 days (range: 2.25–10.75 days). The mortality rate was 26.5 %, and 23 % of patients developed epilepsy with a median follow-up of 9 months. Higher age (≥ 50 years), elevated STESS, ICU admission, use of anesthetic agents, refractory status epilepticus (RSE), and new-onset refractory status epilepticus (NORSE) were significant risk factors for mortality (p<0.05). The development of epilepsy was associated with a higher number of antiseizure medications (ASM) at discharge, ICU admission, use of anesthetic agents, RSE, and NORSE (p<0.05).

Conclusion

NOSE is a neurological emergency with a variable etiology and significant long-term consequences. Approximately one-fourth of patients presenting with NOSE died, and another quarter developed epilepsy during a median follow-up of 9 months. Identifying and addressing the predictors of mortality and epilepsy development following NOSE may improve long-term outcomes.

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新发癫痫状态及其长期预后：一项队列研究

目的新发癫痫状态（NOSE）是癫痫状态的一种亚型，是一种与严重发病率和死亡率相关的神经系统急症。本研究旨在分析 NOSE 患者的表型谱和预后。方法这项前瞻性和回顾性描述性研究纳入了 10 年间出现 NOSE 的患者。收集的数据包括患者的人口统计学特征、SE的表型特征及其病因、癫痫状态严重程度评分（STESS）、SE分类轴II以及入院和出院时的修正Rankin量表（mRS）评分。对出院后至少 6 个月的功能预后和癫痫发作状态进行了评估。结果共纳入 208 名患者，平均年龄（41.97 ± 21.66）岁，男性占多数（57.1%）。47.5%的患者出现局灶性至双侧强直阵挛发作。病因方面，35.57%为急性症状，24%为远期症状。住院时间中位数为 4 天（范围：2.25-10.75 天）。死亡率为 26.5%，23% 的患者在中位 9 个月的随访中发展为癫痫。年龄较大（≥ 50 岁）、STESS 升高、入住 ICU、使用麻醉剂、难治性癫痫状态（RSE）和新发难治性癫痫状态（NORSE）是导致死亡的重要风险因素（p<0.05）。癫痫的发生与出院时服用抗癫痫药物（ASM）的数量较多、入住 ICU、使用麻醉剂、RSE 和 NORSE 有关（p<0.05）。在中位随访 9 个月期间，约四分之一的 NOSE 患者死亡，另有四分之一的患者发展为癫痫。找出并解决 NOSE 后死亡和癫痫发展的预测因素可改善长期预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.