Prevalence Of Status Epilepticus Research Articles

Seizures in inflammatory demyelinating disorders of the central nervous system

BackgroundMultiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may be associated with acute symptomatic seizures and chronic epilepsy as well. The clinical features of the seizures and/or accompanying epilepsy seen in each disease group may vary. In this study, we aimed to contribute to the existing literature by describing the clinical features of seizures and epilepsy in our demyelinating patient population. MethodsWe retrospectively analyzed patients who were followed up in our tertiary referral center neurology demyelinating diseases outpatient clinic between 2019 and 2024. Patients who had at least one seizure before, simultaneously, or after the diagnosis of demyelinating disease were included in the study. ResultsAmong 1735 patients with MS, 40 had experienced at least one epileptic seizure (2.3 %). Thirty patients (1.7 %) had seizures that could not be explained by another factor than MS. When secondary progressive MS (SPMS) and relapsing-remitting MS (RRMS) were compared, the interval between MS-epilepsy diagnosis was longer and seizure recurrence was more in SPMS. However, the prognosis of epilepsy was good in both subtypes. There were 21 patients followed up with antibody-positive neuromyelitis optica spectrum disorder. No patient had a seizure during the follow-up. We identified 56 patients who fulfilled the criteria for MOGAD with high antibody titers. Seizures were observed in three of them (5.4 %). All of them had status epilepticus either at the onset or during the course of the disease. ConclusionEven rare, seizures constitute one of the important clinical features of the inflammatory demyelinating disorders of the central nervous system. The pathophysiologic mechanism underlying seizures in MS is still not clear. Seizures may occur through different mechanisms in patients where seizures are the initial symptom or a sign of relapse and those that occur spontaneously during the progressive course of the disease. Prevalence of status epilepticus was common in MOGAD patients. Given the rarity of the seizures in CNS demyelinating disorders, it is difficult the define clinical and pathophysiological characteristics of accompanying seizures and epilepsy. Future studies conducted on large patient groups will contribute to the existing literature.

English

BACKGROUND Population based studies indicate that the incidence and prevalence of seizure disorders in adults increase with age, especially in elderly, after the age of 60 years. The underlying etiological spectrum is variable across geographies. Analysis of aetiology of seizure is essential for proper treatment to reduce the morbidity and mortality associated with it. The present study was planned to analyse the aetiology of new onset seizures in adult population (> 18 years of age). METHODS The cross sectional study was carried out in the Department of Medicine of MKCG Medical College & Hospital for a period of two years. 100 consecutive cases of new onset seizures admitted in the in-patient department (indoor / ward) were included in the study as per the inclusion and exclusion criteria. The data was collected by the investigators in a pre-tested Case Record Form. Data analysis was done using Microsoft Excel and GraphPad Prism trial version 7.0. Descriptive statistics were presented as proportions for discrete variables and as mean ± SD for continuous variables. P value of ≤ 0.05 was taken as statistically significant. RESULTS Acute symptomatic seizures accounted for 89 % of cases. Neuro-infection was the leading aetiology in 35 % of cases, followed by cerebrovascular accidents (30 %) and metabolic causes (10 %). Neurocysticercosis was seen in 11 % cases, followed by meningitis and cerebral malaria. Among the vascular causes, stroke accounted for 20 %. Prevalence of neuro-infection was highest in the age group of 15 - 35 years. 89 % of idiopathic seizures were generalized tonic-clonic seizure (GTCS). The prevalence of status epilepticus was 8 %. CONCLUSIONS Adult onset seizures have a varied spectrum of aetiology. With a thorough history, clinical examination and appropriate investigations, the aetiology can be identified. Accordingly, treatment can be instituted thus reducing the morbidity and mortality associated with it. KEYWORDS Aetiology, New Seizures, Stroke, Vascular, Neuro-Infection

Multiple Sclerosis and Epilepsy

Amaç: Epilepsi nöbeti Multipl Skleroz’un (MS) nadir bir prezentasyonudur. Bu çalışmada nöbetlerin MS’in seyri ile olan ilişkilerini, rekürren nöbetleri tetikleyebilecek faktörleri, status epileptikus prevelansını ve buna bağlı olarak epilepsi tedavisini başlama yada sürdürmedeki öngörümüzün oluşmasını amaçladık.Yöntem: MS tanılı 995 hastadan epilepsi nöbeti geçiren 56’sı çalışmaya dahil edildi.Hastaların sosyodemografik verileri, hastalık süresi, MS atak sıklığı, nöbet sıklığı, elektroensefalografi bulguları, EDSS skorları Microsoft Office Excel'e kaydedildi.Bulgular: Hastaların çoğu [%68’i (n:38)] kadındı. Ortalama yaş 28±10,5yıldı (min-max:18-61yıl). MS’in ilk atağı nöbet olan hasta 5 (%9) kişi idi. MS tipi ile nöbet varlığı açısından bir fark izlenmedi (p>0,05). Nöbet tipleri ile ortalama EDSS skoru ve MS atak sıklığı açısından karşılaştırıldığında anlamlı bir sonuca varılmadı (p>0,05). 56 hastanın %63’inde (n:35) rekürren nöbetler izlendi. 21 kişi ise 4 yıl boyunca tekrar nöbeti olmadı. Rekürren nöbet açısından CIS/RRMS olma ve ailede epilepsi öyküsü rekürren nöbetler için risk faktörleriydi (p<0,05). Rekürren nöbeti olanların 14 (%40)’ü interferon veya azatiopürin tedavileri; tek nöbeti olanların 8’i (%38) diğer oral MS-tedavilerini kullanmakta olup tedavi ve rekürren nöbet arasında anlamlı bir ilişki izlenmedi (p=0,301).Sonuç: Rekürren nöbet için risk fakörlerini taşıyan MS hastalarının uygun antiepileptik tedaviye başlanarak takiplerinin yapılması önemlidir.

Outcomes of pregnant women with refractory epilepsy

PurposeEpilepsy is the most common neurological disorder requiring medical treatment during pregnancy. However, very few studies are specially dedicated to pregnant women with refractory epilepsy. This study was carried out with the aim of describing obstetrical and neurological outcomes of pregnant women with refractory epilepsy in Brazil. MethodsPregnant women with refractory epilepsy were enrolled in longitudinal cohort study between January 2005 and January 2018. They were regularly followed by a neurologist until the end of pregnancy. Neurological outcomes included seizure control, status epilepticus and adherence to antiepileptic medications. Obstetrical outcomes included major congenital malformations and obstetrical complications. ResultsA total of eighty two patients with a mean age of 24.5 ± 5.5 were included in our study. A significant number of women experienced an increase in seizure frequency and the prevalence of status epilepticus was 8.5%. More than half were non-adherent to antiepileptic drugs. Most of patients required treatment changes during pregnancy, in dose and/or in number of antiepileptic drugs. Cesarean section was the preferred way of delivery and five cases of major congenital malformations were detected. Obstetrical complications were significantly associated with polytherapy, multiple comorbidities, poor adherence to treatment and seizure deterioration during pregnancy (p < 0.05). ConclusionsWomen with refractory epilepsy can have a significant risk of obstetric and neurological complications during pregnancy. Treatment of refractory epilepsy in pregnancy is a real challenge for neurologists.

A study of the etiology and short term outcome of status epilepticus in children

Background: Convulsive status epilepticus is the most common childhood medical neurological emergency, and is associated with significant morbidity and mortality. Most data for this disorder are from mainly adult populations and might not be relevant to childhood. This study was done to obtain a uniquely paediatric perspective. The objective of the study was to the etiology and short term outcome of patients admitted with status epilepticus between the age group 1 month to 12 years at a medical college hospital.Methods: Study design: Prospective descriptive study. Study Place: Department of Paediatrics, SIMS and RC, Bangalore, India. Study population: All children in the age group of 1 month to 12 years admitted with status epilepticus. Sample size:66. Study period: From January 2016 to December 2016.Results: Prevalence of status epilepticus among children admitted in this study was 8.7%. Most common age was found to be 1-3 years (54.5%). Preponderance of male (51.5%) over female (48.5%) was observed. The two most common etiology observed was Atypical febrile seizures (33.3%) and meningitis (22.7%). 57.5% children presented as first episode of seizure and duration of seizure was less than 2 hours in 65.1%.In our study, short term mortality rate was found to be 3% and morbidity was found to be 9% and meningitis was responsible for all the deaths. The mortality and morbidity in the form of neurodeficits were observed between the age group of 1 month to 3 years. Based on the duration of seizure lasting more than 8 hours, two third had mortality and one third had morbidity.Conclusions: Status epilepticus is a severe life threatening emergency with substantial morbidity and mortality. Major causes were due to atypical febrile seizure and meningitis. Patients with younger age, male sex and seizures lasting longer duration had higher mortality and morbidity, predicting the poor outcome.

A national database of incidence and treatment outcomes of status epilepticus in Thailand

Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.