PROSPECTIVE POPULATION BASED STUDY IN ADULTS OF REFRACTORY STATUS EPILEPTICUS: CLINICAL PRESENTATION, FREQUENCY, MORTALITY AND RISK FACTORS
Abstract number :
2.003
Submission category :
Year :
2003
Submission ID :
2267
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Robert DeLorenzo, Alan Towne, Elizabeth Waterhouse, Venkata Jakkamppudi, Linda Garnett, Dajun Ko Neurology, Virginia Commonwealth University, Richmond, VA; Pharmacology and Toxicology, and Molecular Biohysics and Biochemistry, Virginia Commonwealth Univer
Refractory status epilepticus (RSE) is a major neurological emergency and represents a severe form of status epilepticus (SE) that does not respond to first and second treatment efforts with anticonvulsant medications. Few large prospective studies have been initiated to evaluate this condition. It is important to understand the clinical presentation, frequency, mortality, and risk factors for this condition. Thus, this study was initiated to evaluate this condition in a large prospective population study in Richmond, VA.
RSE patients were identified in the prospectrive population based Richmond SE data base. 148 cases of RSE were identified in 539 SE patients. RSE was defined as SE patients that did not respond to first and second treatments of aniconvulsant drugs. Mortality was defined as death within 30 days or less after the onset of SE. Definitions of etiology, seizure type, and risk factors and statistical methods were conducted as desribed previously (Neurology 1996;46:1029-1035).
In a population of 539 SE cases 239 episodes stopped seizing after the first treatment and in the remaining 300 episodes seizure activity continued after the initial treatment (56%). 148 out of 539 SE cases (28%) failed to respond to a second treatment and thus comprised the population of RSE. Thus, 28% of the adult SE cases met the definition of RSE in the Richmond population. The mortality of RSE was 41% in comparison to a mortality of 26% in the total SE population, including both RSE plus non RSE (n=539). Non RSE had a lower mortality. There were no statistically significant differnces between SE and RSE for gender, time to initial treatment or age. Several univariate statistically significant differences were found in the presentation of SE and RSE for etiology, seizure type, race, location of onset (in or out of hospital) and seizure history. Multivariate analysis considering all the variables together demonstrated that seizure type, seizure history, and location of onset were statistically significant predictors of RSE.
RSE is associated with a significant increase in mortality in comparison to SE. The data indicate that delay to first treatment is not enough to explain the development of RSE and that other variables are involved. Seizure type, seizure history, and location of onset of SE may play a role in predicting the development of RSE and may offer an insight into the underlying factors leading to the pathophysiology of RSE.
[Supported by: NIH-NINDS Grants P50NS25630 and RO1NS23350.]