Abstracts

RATIONALE: Status Epilepticus (SE) is a medical emergency associated with significant mortality. This study examines morbidity in terms of functional outcome in pediatric, adult and elderly SE cases in a large population-based SE database.
: At the end of this activity, participants should be able to discuss factors related to functional outcome in children, adults and elderly patients who have experienced SE.
METHODS: Data was obtained from the NIH Greater Richmond Metropolitan Area Status Epilepticus Database, a prospective population-based study. Morbidity was measured using the Glasgow Outcome Scale (GOS), scored as follows: 5 = good recovery/normal (may have mild deficits), 4 = moderate disability (disabled but independent - able to perform activities of daily living [ADL[ssquote]s]), 3 = severe disability (conscious but disabled) - dependent with ADL[ssquote]s, 2 = coma/persistent vegetative state, 1 = dead. Scores were recorded to reflect functional status prior to SE, at discharge, and 30 days after SE for cases with long hospitalizations. Cases were divided into 3 groups: those who had the same score after SE as they had before SE (same), those who had a decrease in function after SE (worsened), and those who died. Chi square was used to test significance; very few cases showed an improvement after SE and were not included in statistical analysis. Cases were divided into 3 age categories: pediatric cases included 1 month of age up to 16 years old, adult cases included those aged 16 up to 60 years of age, and the elderly group consisted of those cases 60 years of age and greater.
RESULTS: A total of 698 cases had GOS scores available for analysis. Of these, 264 (38%) were pediatric, 193 (28%) were adult, and 241 (34%) were elderly. Combined morbidity and mortality was highest in the elderly group (48%), compared with adult (35%) and pediatric groups (10%). Mortality was significantly higher in the elderly (36%) and lower in pediatric cases (5%) than in adult cases (26%), p[lt].0001 In the survivors there were also statistically significant changes in functional outcome by age group. Of the pediatric cases, 94% stayed the same and 6% worsened, while in adults 81% remained the same and 19% worsened and in the elderly group only 64% remained the same and 36% worsened (p[lt].0001). There were no statistically significant differences in outcome by gender or race in any of the age groups. In all age groups there were statistically significant differences in outcome with relation to seizure history: fewer cases with a previous seizure history worsened (p[lt].004), and there were also similar findings in adult and elderly cases with a previous history of SE (p[lt].004).
CONCLUSIONS: Following SE, children are likely to maintain functional abilities, while the elderly are likely to deteriorate. Patients with a previous history of seizures and/or SE are less likely to experience functional deterioration. These findings have important implications for prognosis and rehabilitation of patients with SE.
[Supported by: NIH P01 NS25630]