Prediction of long-term unprovoked seizures after status epilepticus.
epilepsy
status epilepticus
treatment
unprovoked seizure
Journal
Epilepsia
ISSN: 1528-1167
Titre abrégé: Epilepsia
Pays: United States
ID NLM: 2983306R
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
revised:
21
06
2023
received:
05
01
2023
accepted:
21
06
2023
medline:
20
9
2023
pubmed:
22
6
2023
entrez:
22
6
2023
Statut:
ppublish
Résumé
Possible long-term consequences of status epilepticus (SE) include cognitive and behavioral impairment and the development of chronic epilepsy. However, these aspects have not been systematically studied in clinical practice. We aimed to evaluate long-term seizure recurrence after SE and the potential risk factors for their development. Data were obtained from a prospective registry of all SE episodes occurring in adult patients who attended our center from February 2011 to April 2022. Clinical data, electroencephalographic findings, treatment, and long-term data were prospectively recorded. We performed a cross-sectional study of consecutive SE patients without previous epilepsy diagnosis, and analyzed the development of unprovoked remote seizures. A total of 849 patients were registered in the database. After excluding in-hospital mortality (198/849, 23.3%) and patients with prior epilepsy history (291/849, 44.7%), 360 patients (42.4%) with a first SE episode were included. The median age was 68 years (interquartile range [IQR] = 56-79), and 176 patients (48.9%) were women. The median time to first-line treatment initiation was 2 h (IQR = .7-7.4), and it was correlated with SE duration (R = .375, p < .001). One hundred nine patients (30.3%) presented unprovoked seizures during a median follow-up of 1.8 years (IQR = .5-4.3). After adjusting for identifiable confounders in a multivariable Cox regression analysis, progressive symptomatic etiology (hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.17-3.33, p = .011), time to first-line treatment initiation > 1.5 h (HR = 1.89, 95% CI = 1.25-2.87, p = .003), and superrefractory SE (HR = 2.34, 95% CI = 1.26-4.33, p = .007) were independently associated with a greater risk of unprovoked seizure recurrence. In contrast, older patients (HR = .99, 95% CI = .97-.99, p = .021) and an acute symptomatic etiology (HR = .44, 95% CI .28-.68, p < .001) were at lower risk of unprovoked seizure recurrence. The etiology of SE, the delay in initiating SE treatment, and the presence of superrefractoriness have been identified as potentials factors associated with unprovoked remote seizures following a new onset SE. Therefore, prompt and appropriate management should be applied to avoid seizure recurrence.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2399-2408Informations de copyright
© 2023 International League Against Epilepsy.
Références
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus-report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515-23.
Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11(12):800-10.
Meierkord H. The risk of epilepsy after status epilepticus in children and adults. Epilepsia. 2007;48(Suppl 8):94-5.
Neligan A, Shorvon SD. Prognostic factors, morbidity and mortality in tonic-clonic status epilepticus: a review. Epilepsy Res. 2011;93(1):1-10.
Leitinger M, Holler Y, Kalss G, Rohracher A, Novak HF, Hofler J, et al. Epidemiology-based mortality score in status epilepticus (EMSE). Neurocrit Care. 2015;22(2):273-82.
Gonzalez-Cuevas M, Santamarina E, Toledo M, Quintana M, Sala J, Sueiras M, et al. A new clinical score for the prognosis of status epilepticus in adults. Eur J Neurol. 2016;23(10):1534-40.
Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adults. Neurology. 2006;66(11):1736-8.
Roberg LE, Monsson O, Kristensen SB, Dahl SM, Ulvin LB, Heuser K, et al. Prediction of long-term survival after status epilepticus using the ACD score. JAMA Neurol. 2022;79(6):604-13.
Punia V, Garcia CG, Hantus S. Incidence of recurrent seizures following hospital discharge in patients with LPDs (PLEDs) and nonconvulsive seizures recorded on continuous EEG in the critical care setting. Epilepsy Behav. 2015;49:250-4.
Punia V, Ellison L, Bena J, Chandan P, Sivaraju A, George P, et al. Acute epileptiform abnormalities are the primary predictors of post-stroke epilepsy: a matched, case-control study. Ann Clin Transl Neurol. 2022;9(4):558-63.
Pedersen GL, Rasmussen SB, Gyllenborg J, Benedek K, Lauritzen M. Prognostic value of periodic electroencephalographic discharges for neurological patients with profound disturbances of consciousness. Clin Neurophysiol. 2013;124(1):44-51.
Chen DF, Kumari P, Haider HA, Ruiz AR, Lega J, Dhakar MB. Association of epileptiform abnormality on electroencephalography with development of epilepsy after acute brain injury. Neurocrit Care. 2021;35(2):428-33.
Gutierrez-Viedma A, Parejo-Carbonell B, Romeral-Jimenez M, Sanz-Graciani I, Serrano-Garcia I, Cuadrado ML, et al. Therapy delay in status epilepticus extends its duration and worsens its prognosis. Acta Neurol Scand. 2021;143(3):281-9.
Santamarina E, Gonzalez M, Toledo M, Sueiras M, Guzman L, Rodriguez N, et al. Prognosis of status epilepticus (SE): relationship between SE duration and subsequent development of epilepsy. Epilepsy Behav. 2015;49:138-40.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7.
Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61.
Hirsch LJ, Gaspard N, van Baalen A, Nabbout R, Demeret S, Loddenkemper T, et al. Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions. Epilepsia. 2018;59(4):739-44.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82.
Raspall-Chaure M, Chin RF, Neville BG, Scott RC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006;5(9):769-79.
Gainza-Lein M, Barcia Aguilar C, Piantino J, Chapman KE, Sanchez Fernandez I, Amengual-Gual M, et al. Factors associated with long-term outcomes in pediatric refractory status epilepticus. Epilepsia. 2021;62(9):2190-204.
Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005;76(4):534-9.
Sculier C, Barcia Aguilar C, Gaspard N, Gainza-Lein M, Sanchez Fernandez I, Amengual-Gual M, et al. Clinical presentation of new onset refractory status epilepticus in children (the pSERG cohort). Epilepsia. 2021;62(7):1629-42.
Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015;85(18):1604-13.
Gainza-Lein M, Sanchez Fernandez I, Jackson M, Abend NS, Arya R, Brenton JN, et al. Association of Time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol. 2018;75(4):410-8.
Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia. 1994;35(1):27-34.
Pan Y, Feng Y, Peng W, Cai Y, Ding J, Wang X. Timing matters: there are significant differences in short-term outcomes between two time points of status epilepticus. BMC Neurol. 2022;22(1):348.
Bonduelle T, Ollivier M, Trin K, Thomas B, Daubigney A, Michel V, et al. Association of Peri-ictal MRI abnormalities with mortality, antiseizure medications refractoriness, and morbidity in status epilepticus. Neurology. 2022;100:e943-53.
Hill CE, Parikh AO, Ellis C, Myers JS, Litt B. Timing is everything: where status epilepticus treatment fails. Ann Neurol. 2017;82(2):155-65.
Gutierrez-Viedma A, Romeral-Jimenez M, Serrano-Garcia I, Parejo-Carbonell B, Cuadrado-Perez ML, Sanz-Graciani I, et al. The importance of timing in epilepsia partialis continua. Neurologia (Engl Ed). 2022;37(4):263-70.
Uppal P, Cardamone M, Lawson JA. Outcomes of deviation from treatment guidelines in status epilepticus: a systematic review. Seizure. 2018;58:147-53.
Sathe AG, Underwood E, Coles LD, Elm JJ, Silbergleit R, Chamberlain JM, et al. Patterns of benzodiazepine underdosing in the established status epilepticus treatment trial. Epilepsia. 2021;62(3):795-806.
Tirupathi S, McMenamin JB, Webb DW. Analysis of factors influencing admission to intensive care following convulsive status epilepticus in children. Seizure. 2009;18(9):630-3.