Abstract
The study aimed to group acute symptomatic aetiologies of consecutive episodes of status epilepticus (SE) into different subcategories and explore their associations with clinical outcome. Aetiologies were firstly categorized as “acute”, “remote”, “progressive”, “SE in defined electroclinical syndromes”, and “unknown”. Four subcategories of acute aetiologies were then defined: i) withdrawal, or low levels, or inappropriate prescription of antiseizure medications, or sleep deprivation in patients with pre-existing epilepsy; ii) acute insults to central nervous system (CNS) (“acute-primary CNS”); iii) CNS pathology secondary to metabolic disturbances, systemic infection, or fever (“acute-secondary CNS”); and iv) drug/alcohol intoxication or withdrawal. Poor outcome at discharge, defined as worsening of clinical conditions (modified Rankin Scale [mRS] at discharge higher than mRS at baseline), was reported in 55.6% of cases. The aetiological categories of acute-primary CNS (OR 3.61, 95% CI 2.11-6.18), acute-secondary CNS (OR 1.80, 95% CI 1.11-2.91) and progressive SE (OR 2.65, 95% CI 1.57-4.47), age (OR 1.05, 95% CI 1.04-1.06), non-convulsive semiology with coma (OR 3.06, 95% CI 1.52-6.17), refractoriness (OR 4.31, 95% CI 2.39-7.77) and super-refractoriness to treatment (OR 8.24, 95% CI 3.51-19.36) increased the odds of poor outcome. Heterogeneity exists within the spectrum of acute symptomatic causes of SE and distinct aetiological subcategories may inform about the clinical outcome.
AGO