HOUSTON—Predictors of poor outcomes in patients with status epilepticus admitted to the neurointensive care unit include complex partial status epilepticus (CPSE), refractory status epilepticus, or the development of nonconvulsive status epilepticus (NCSE), according to research presented at the 70th Annual Meeting of the American Epilepsy Society.
“Not a lot of data exist as to what predicts the poor outcomes and what’s known about the outcome in patients with status epilepticus,” said Advait Mahulikar, MD, a neurology resident at Wayne State University in Detroit.
Advait Mahulikar, MD
Dr. Mahulikar and colleagues retrospectively reviewed data from 100 patients with status epilepticus who were admitted to the neurointensive care unit at Detroit Medical Center from November 2013 to January 2016. Variables of interest included patient demographics, initial presentation, refractoriness to treatment, presence or absence of underlying etiology, past history of epilepsy, and use of benzodiazepines on admission. NCSE was another variable of interest, either from initial presentation or developed during the course of convulsive status epilepticus. A good outcome was defined as a Glasgow Outcome Scale (GOS) score of 4 or 5, and a poor outcome was defined as a GOS score of 1 to 3.
The mean age of the 100 patients was 58; 53% were male, 84% were African American, and 70% had a history of epilepsy. The median hospital length of stay was seven days and the median neurointensive care unit length of stay was three days. Good outcomes occurred in 69 patients.
Neither age nor gender predicted poor outcome, and there was no difference in outcome between structural and nonstructural causes of status epilepticus. However, prior history of epilepsy was a strong negative predictor of poor outcome. Fourteen out of 70 patients (20%) with a prior history of epilepsy had a poor outcome. “The theory is that [these patients] were already on treatment for epilepsy in the past and that affected their outcome in a positive way,” said Dr. Mahulikar.
When outcome was analyzed based on status semiology on initial presentation, poor outcome was observed in 16 of the 37 patients (43%) with CPSE, nine of 48 patients (19%) with generalized convulsive status epilepticus, all patients with myoclonic status epilepticus (n = 2), and three of nine (33%) who had NCSE. The type of status epilepticus was unknown for four patients, one of whom had an unknown outcome. NCSE at any time during the hospital course was seen in 31 patients; 14 (45%) had a poor outcome.
The mean number of ventilator days was higher in patients with NCSE than in those without NCSE (9.2 vs 1.6 days) and also higher in those with new-onset seizures than in those without (7.8 vs. 2.9 days). Analysis of methods of treatment revealed that only seven of 31 (22.5%) patients who received adequate benzodiazepine dosing had poor outcomes.
“The take-home message is to diagnose NCSE as early as possible,” said Dr. Mahulikar. Neurologists may attribute some cases incorrectly to metabolic or autoimmune causes on their initial presentation. “Treat aggressively at the beginning,” Dr. Mahulikar advised.
—Doug Brunk
Suggested Reading
Power KN, Gramstad A, Gilhus NE, Englesen BA. Prognostic factors of status epilepticus in adults. Epileptic Disord. 2016;18(3):297-304.
Sutter R, De Marchis GM, Semmlack S, et al. Anesthetics and outcome in status epilepticus: A matched two-center cohort study. CNS Drugs. 2017;31(1):655-674.