Abstract
BackgroundStatus epilepticus (SE) is a medical emergency with high mortality rates. Of all SE’s, 7% are caused by a brain tumor. Clinical guidelines on the management of SE do not make a distinction between tumor-related SE and SE due to other causes. However, pathophysiological research points towards specific mechanisms of epilepsy in brain tumors. We investigated whether clinical features support a distinct profile of tumor-related SE by looking at measures of severity and response to treatment.MethodsSystematic review of the literature and meta-analysis of studies on adult SE that report separate data for tumor-related SE and non-tumor-related SE on the following outcomes: short-term mortality, long-term morbidity, duration of SE, and efficacy of anticonvulsant intervention.ResultsFourteen studies on outcome of SE were included. Tumor-related SE was associated with higher mortality than non-tumor-related SE (17.2% versus 11.2%, RR 1.53, 95%-CI 1.24-1.90). After exclusion of patients with hypoxic-ischemic encephalopathy (a group with a known poor prognosis) from the non-tumor-group, the difference in mortality increased (17.2% versus 6.6%; RR 2.78, 95%-CI 2.21 – 3.47). Regarding long-term morbidity and duration of SE there were insufficient data. We did not find studies that systematically compared effects of therapy for SE between tumor- and non-tumor-related SE.ConclusionsBased on – mostly retrospective – available studies, short-term mortality seems higher in tumor-related SE than in SE due to other causes. Further studies on the outcome and efficacy of different therapeutic regimens in tumor-related SE are needed, to clarify whether tumor-related SE should be regarded as a distinct clinical entity.
Highlights
Status epilepticus (SE) is a medical emergency with high mortality rates
Outcome of status epilepticus For the first search, the term status epilepticus was combined with outcome, mortality, morbidity, fatality, prognosis, coma, death, incidence, prevalence and epidemiology
For a paper to be included in this literature review, status epilepticus had to be defined as a single continuous seizure or a series of epileptic seizures with clouded consciousness between ictal events; most studies used a minimum duration of 30 minutes in the definition, we did not use this as an inclusion criterion since modern data and guidelines use less stringent time criteria [6]
Summary
Status epilepticus (SE) is a medical emergency with high mortality rates. Of all SE’s, 7% are caused by a brain tumor. In low-grade tumors, slow growth probably gives rise to the development of focal or remote cell changes. These cell changes are associated with epileptogenesis. In most national and international guidelines, SE is considered a single clinical entity, there is a consensus that partial and non-convulsive forms of SE should not be treated as aggressively as generalized convulsive SE. In these types of SE, the risk of intensive sedative treatment and intubation probably does not outweigh the benefits of seizure control [8]. Most clinical guidelines on the management of SE do not make a distinction between tumor-related SE and SE due to other causes
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