Abstracts

Rationale: Status Epilepticus (SE) is a frequently encountered neurological emergency with a high rate of morbidity and mortality. Our primary objective was to determine incidence of status Epilepticus over last 19 years. We also wanted to investigate causes and outcomes of SE. Methods: For this retrospective study we identified 653 cases of Status Epilepticus admitted to 5 different ITU departments in NHS Greater Glasgow and Clyde between 1996-2013 by using clinical codes. Medical records were reviewed in detail. We collected information about age, sex, prior history of epilepsy, antiepileptic medications, alcohol and drug use, type of SE, possible causes/triggers, treatment, length of ITU stay and outcomes. Results: Incidence: To compare incidence across time we divided the cohort into two groups, 1995-2004 and 2005-2013.Between 1995 – 2004, 250 patients were admitted to ITU with SE. Between 2005 – 2013, 403 patients were admitted to ITU with SE. The incidence of SE would appear to have increased over years.     Causes of status and outcomes Of the total assessed, 396 patients (60.6%) had SE without prior diagnosis of epilepsy (‘De Novo Status Epilepticus – DNSE) and no information was available on prior epilepsy for 32 patients (5%). These two cohort of patients were grouped together leading to total of 428 patients. 225 patients had a previous diagnosis of epilepsy (34.4%).   De Novo group 49% cases of status epilepticus were precipitated by alcohol and/or non-prescription drugs. Other causes included, metabolic13%, Head injuries, extra and intracerebral haemorrhage 11.7%, stroke 9%, sepsis 6%, CNS infection 5%, tumour 3%, post-surgery 3%, idiopathic 2.5%, neuro-inflammation 3%, Pseudo seizure 1.8%, structural malformation 1.8%, medication interaction 1.6% and 1st seizure 0.4%. Only 0.9% cases had status related to complication of pregnancy. No information was available regarding causation of status epilepticus for 5% of cases. Outcome studies in this group showed 30% patients recovered with no deficit, 23% recovered with neurological deficit and in 37% cases outcome data was not available. Mortality during admission occurred in 12.6% (n=56). One year after admission mortality rate was 25% (n=107) and at 5-year mortality was 41% (n=175). 225 patients had previous diagnosis of epilepsy. The most commonly identified cause for status epilepticus was alcohol and drug abuse 31.5%. No cause was identified in 15% of cases, Other causes included non-compliance 14%, progressive epilepsy syndrome and poorly controlled epilepsy 11%, sepsis 9%, change in medication 7%, head injury and subdural bleeds 7.5%, metabolic 5%, pseudo seizures 4%, intracranial structural problem 4%, post-surgery 2%, stroke disease 2%, brain infection 1.7%, neuro- inflammation 1.3%, pregnancy related 0.8% and brain tumour 0.8%. 52% patients recovered with no deficit,19.5% recovered with deficit, no outcome data was available for 22 % patients. Immediate mortality was 7% (n=16).1-year mortality was 15.5% (n=34) and 5-year mortality was 26 % (n=57). Conclusions: Preliminary data suggests that the incidence of SE would appear to have increased over last decade. DNSE leading to ITU admission is more common (65% of all 653 cases) than SE as a complication of epilepsy. In our sample, 43% (of all 653 cases of SE) were caused by chronic alcohol and drugs intake. Patients with known epilepsy have better outcomes and less immediate and long-term mortality than those with DNSE. Funding: Nil