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Observational Study
. 2022 Sep 14;22(1):348.
doi: 10.1186/s12883-022-02868-y.

Timing matters: there are significant differences in short-term outcomes between two time points of status epilepticus

Yiwen Pan  1 , Yu Feng  1 , Weifeng Peng  1 , Yang Cai  1 , Jing Ding  2   3 , Xin Wang  4   5
Affiliations
Observational Study

Timing matters: there are significant differences in short-term outcomes between two time points of status epilepticus

Yiwen Pan et al. BMC Neurol. .

Abstract

Background: In 2015, the International League Against Epilepsy proposed a new conceptual definition of status epilepticus (SE) with two operational dimensions (t1 and t2) to guide emergency treatment. The purpose of this study was to compare clinical characteristics and prognoses of patients at these two different time points.

Methods: We conducted a prospective observational cohort study of consecutive adults diagnosed with SE. In case of convulsive SE, t1 is 5 min and t2 is 30 min, whereas in case of focal SE with impaired consciousness, t1 is 10 min, t2 is 60 min. Data on clinical characteristics, including age, gender, history of prior seizures, neuroimaging, semiology, duration, and etiology of SE, were collected. The primary outcome was mortality, with seizure recurrence as a secondary measure, and functional status as tertiary outcome of enrolled patients at 3 months after SE onset.

Results: We screened one hundred patients with SE, with a median age of 66 years and 61% were male. Fifty-six (56.0%) patients reached t1 of SE, while 44 (44.0%) reached t2 of SE. Convulsive SE (52.0%, n = 52) was more common than focal SE with impaired consciousness (48.0%, n = 48). Status epilepticus secondary to an acute symptomatic process was the most common (50%, n = 50). Patients meeting t2 of SE demonstrated a remarkably increased risk of mortality (unadjusted analysis-RR 3.606, 95%CI 1.552-8.376, p = 0.003; adjusted analysis-RR 2.924, 95%CI 1.221-7.003, p = 0.016) and unfavorable functional status (unadjusted analysis-RR 1.803, 95%CI 1.280-2.539, p = 0.001; adjusted analysis-RR 1.664, 95%CI 1.184-2.340, p = 0.003) at 3 months compared to those who only reached t1 of SE. Patients reaching t2 of SE were more likely to experience seizure recurrence, however, there was no significant difference between the two cohorts.

Conclusions: Our study provides strong support for the new definition of SE. Patients meeting t2 of SE tend to have a remarkably increased risk of mortality and unfavorable functional outcomes compared to those who only reached t1 of SE. Furthermore, patients were likely to experience seizure recurrence after undergoing an episode of SE. Physicians must be educated about prompt recognition and appropriate management of SE.

Keywords: Functional status; Mortality; Seizure duration; Seizure recurrence; Status epilepticus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study cohort. One hundred patients were enrolled for final analysis between June 1, 2017, and December 31, 2018. Fifty-six (56.0%) patients reached t1 of SE, while 44 (44.0%) reached t2 of SE. Clinical characteristics and prognoses of patients were presented briefly. mRS: modified Rankin Scale, SE: status epilepticus
See this image and copyright information in PMC

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