Abstracts

Rationale: Although status epilepticus (SE) is an urgent, life-threatening condition, studies concerning this topic are scarce, especially in countries, where different composition of SE causes is observed and different treatment guidelines are used. The goal of our study was to assess the causes, epidemiological rates (incidence and mortality) and treatment outcomes (case fatality, duration of SE and hospitalization) of SE in Lithuania - the country with gene-pool homogeneity. Methods: We collected all case histories of patients, who experienced SE between 2005-2009 and were admitted to Vilnius hospitals with intensive care unit. Data regarding sociodemographic variables, previous medical history and concomittant treatment were collected. Cause, type and duration of SE, latency from onset to treatment start, diagnostic procedures (CT, EEG, biochemistry at the time of admission), treatment (medications, dosage, other measures) and outcomes (fatality, duration of hospitalization)were assessed. We used Student‘s T, Mann-Whitney U, binomial,chi square, Pearson‘s and Spearman‘s correlation tests for our statistical analysis. Results: We studied 591 SE cases with clear male predominance (67.5 %). The age of patients ranged from 18 to 106 years (mean 52.75±16.05). Metabolic cause of SE was found in 244 (41.29%) and structural CNS lesions in 143 (24.2%) patients. 402 had epilepsy before (group SE1) and 189 - had not (SE2).The incidence of SE was 21.66 cases per 100‘000 per year. SE2 patients were older (t=-3.78; p<0.001). Mean duration of SE was 8.34±29.9h. Average duration of hospitalization was 6.75±4.87 days. SE caused by structural CNS lesions lasted longer while caused by metabolic factors - shorter. Mean latency from onset to treatment start was 2.73±9.52h. Furthermore, it was longer for older patients and people with epilepsy. We found strong correlation between duration of SE and: a) time to treatment initiation (r=0.552; p<0.001), b) duration of hospitalization (r=0.313; p<0.001), c) blood glucose (ρ=0.11; p=0.007) and potassium (ρ=-0.09; p=0.03) levels. Mortality rate was 1.6/100‘000/yr, case fatality - 7.1%. Higher fatality was among older patients (t=3.79; p<0.001), SE2 (χ2=15.77; p<0.001) and those with structural SE cause (χ2=72.88; p<0.001). Those with metabolic SE cause had better outcomes (χ2=21.74; p<0.001). Death rate was associated with treatment delay (Z=-1.94; p=0.05). Duration of hospitalization correlated with patient‘s age (r=0.215; p<0.001) and was longer for structural SE (Z=-2.33; p=0.02). Conclusions: Status epilepticus can be terminated successfully and with low in-hospital mortality in the vast majority of the patients. Delayed initiation of treatment determine longer duration of SE and hospitalization as well as higher fatality rate. Patients without epilepsy history who developed SE have higher fatality rate.