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. 2016 Jul;95(30):e4092.
doi: 10.1097/MD.0000000000004092.

Early-onset status epilepticus in patients with acute encephalitis

Romain Sonneville  1 , Eric Mariotte, Mathilde Neuville, Sébastien Minaud, Eric Magalhaes, Stéphane Ruckly, Marie Cantier, Guillaume Voiriot, Aguila Radjou, Roland Smonig, Jean-François Soubirou, Bruno Mourvillier, Lila Bouadma, Michel Wolff, Jean-François Timsit
Affiliations

Early-onset status epilepticus in patients with acute encephalitis

Romain Sonneville et al. Medicine (Baltimore). 2016 Jul.

Abstract

Status epilepticus (SE) is a common complication of acute encephalitis, but its determinants and prognostic value in this setting are not known.Risk factors for early-onset SE (within 48 hours of intensive care unit [ICU] admission) in consecutive adult patients with all-cause encephalitis admitted to the medical ICU of a university hospital (1991-2013) were evaluated by multivariate logistic regression analysis. To examine the prognostic value of SE, patients were classified into 3 groups: no SE, nonrefractory SE (NRSE), and refractory SE (RSE). Poor neurologic outcome was defined by a modified Rankin score of 4 to 6.Among the 290 patients, 58 (20%, 95% CI: 15%-25%) developed early-onset SE, comprising 44 patients with NRSE and 14 patients with RSE. Coma (adjusted odds ratio [OR]: 3.1, 95% CI: 1.5-6.3), cortical lesions on neuroimaging (adjusted OR: 3.7, 95% CI: 1.8-7.8), and nonneurologic organ failure(s) (adjusted OR: 13.6, 95% CI: 4.9-37.7) were found to be independent risk factors for SE. By contrast, a bacterial etiology had a protective effect (adjusted OR: 0.3, 95% CI: 0.1-0.7). Age, body temperature, and blood sodium levels were not independently associated with SE. Poor neurologic outcomes were observed at day 90 in respectively 23% (95% CI: 17%-28%), 23% (95% CI: 10%-35%), and 71% (95% CI: 48%-95%) of no SE, NRSE, and RSE patients (P < 0.01). After adjusting for confounders, RSE, but not NRSE, remained independently associated with 90-day mortality (adjusted OR: 6.0, 95% CI: 1.5-23.3).Coma, cortical involvement on neuroimaging, and nonneurologic organ failure(s) are independent risk factors for SE in patients with acute encephalitis. Conversely, a bacterial etiology is associated with a lower risk of SE.These findings may help identify patients who may benefit from prophylactic antiepileptic drugs.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

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Box 1
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Figure 1
Figure 1
Cause-specific prevalence of status epilepticus in adults with encephalitis. HSV = Herpes simplex virus, VZV = Varicella-zoster virus.
Figure 2
Figure 2
Day-90 neurologic outcomes.
See this image and copyright information in PMC

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