Incident Status Epilepticus Research Articles

High long-term mortality after incident status epilepticus in adults: Results from a population-based study.

To determine annual incidence, etiology, severity, and short- and long-term mortality of first-time, nonanoxic status epilepticus (SE) in adults in a population-based retrospective cohort study. We systematically identified all episodes of SE in the year 2014 on the island of Funen. Patients with SE due to anoxia, patients with recurrent SE, and patients <18years old were excluded. Nonconvulsive SE in coma was diagnosed according to the Salzburg criteria. Etiology, semiology, modified Rankin Scale (mRS) at discharge, survival, and the Status Epilepticus Severity Score were retrospectively determined from patients' records. Patients with first-time nonanoxic SE diagnosed during 2008-2013 from our database (n=88) were used to confirm the results. The incidence of first-time, nonanoxic SE in 2014 was 10.7/100000 persons at risk (n=41). Median Status Epilepticus Severity Score was 3; in-hospital mortality was 24.4%. After median follow-up of 39.2months, 53.7% of the patients had died (age- and gender-adjusted mortality rate of 5.2/100000). Mortality stabilized 2years after diagnosis. Analysis of the cohort from 2008-2013 confirmed stabilization of survival after 2-3years and the high mortality 2years after discharge. When correcting for acute symptomatic causes, the in-hospital mortality was 16.7% and 46.7% at follow-up (crude mortality rate of nonhypoxic and nonacute symptomatic SE = 3.5/100000). An exploratory multivariate analysis of pooled patients with SE from 2008 to 2014 revealed mRS≥2 at discharge as a prognostic factor for long-term mortality. In this cohort, the overall mortality of first-time nonhypoxic SE was >50%. Mortality of SE after discharge was substantially higher than in-house mortality and stabilized after 2years. The degree of disability as indicated by mRS at discharge was associated with long-term mortality after discharge.

Prediction of awakening from hypothermic postanoxic coma based on auditory discrimination.

Most of the available clinical tests for prognosis of postanoxic coma are informative of poor outcome. Previous work has shown that an improvement in auditory discrimination over the first days of coma is predictive of awakening. Here, we aimed at evaluating this test on a large cohort of patients undergoing therapeutic hypothermia and at investigating its added value on existing clinical measures. We recorded electroencephalographic responses to auditory stimuli in 94 comatose patients, under hypothermia and after rewarming to normal temperature. Auditory discrimination was semiautomatically quantified by decoding electroencephalographic responses to frequently repeated versus rare sounds. Outcome prediction was based on the change of decoding performance from hypothermia to normothermia. An increase in auditory discrimination from hypothermia to normothermia was observed for 33 of 94 patients. Among them, 27 awoke from coma, resulting in a positive predictive value of awakening of 82% (95% confidence interval = 0.65-0.93). Most nonsurvivors showing an improvement in auditory discrimination had incident status epilepticus. By excluding them, 27 of 29 patients with improvement in auditory discrimination survived, resulting in a considerable improvement of the predictive value for awakening (93%, with 95% confidence interval = 0.77-0.99). Importantly, this test predicted the awakening of 13 of 51 patients for whom the outcome was uncertain based on current tests. The progression of auditory discrimination from hypothermia to normothermia has a high predictive value for awakening. This quantitative measure provides an added value to existing clinical tests and encourages the maintenance of life support. Ann Neurol 2016;79:748-757.

Status epilepticus: impact of therapeutic coma on outcome.

Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome. Retrospective assessment of a prospectively collected cohort. Academic hospital. Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013. We recorded prospectively demographics, clinical status epilepticus features, treatment, and outcome at discharge and retrospectively medical comorbidities, hospital stay, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with therapeutic coma. Therapeutic coma was associated with poorer outcome in the whole cohort (relative risk ratio for new disability, 6.86; 95% CI, 2.84-16.56; for mortality, 9.10; 95% CI, 3.17-26.16); the effect was more important in patients with complex partial compared with generalized convulsive or nonconvulsive status epilepticus in coma. Prevalence of infections was higher (odds ratio, 3.81; 95% CI, 1.66-8.75), and median hospital stay in patients discharged alive was longer (16 d [range, 2-240 d] vs 9 d [range, 1-57 d]; p < 0.001) in subjects managed with therapeutic coma. This study provides class III evidence that therapeutic coma is associated with poorer outcome after status epilepticus; furthermore, it portends higher infection rates and longer hospitalizations. These data suggest caution in the straightforward use of this approach, especially in patients with complex partial status epilepticus.