Unraveling the mystery of status epilepticus: a retrospective study at a tertiary care centre from India

Abstract

Introduction: Status epilepticus (SE) is a neurological emergency associated with substantial morbidity and mortality. Data from tertiary care centres in low- and middle-income settings remain limited, and the heterogeneity of aetiology, presentation, treatment response, and outcome continues to obscure clear prognostic patterns.1,2 This study aimed to characterise the demographic, clinical, biochemical, electrographic, and therapeutic profile of patients admitted with SE, and to identify factors associated with poor functional outcome. Methods: We conducted a retrospective observational study of 100 consecutive adult patients admitted with SE to a tertiary care hospital in India. Demographics, clinical features, laboratory parameters, imaging, electroencephalography (EEG), antiseizure medication (ASM) use, and Status Epilepticus Severity Score (STESS) were recorded. Outcome was assessed using the modified Rankin Scale (mRS) at discharge and dichotomised as good (mRS 0–2) or poor (mRS 3–6). Continuous variables were compared using Welch's t-test and categorical variables using the chi-square test; p < 0.05 was considered significant. Results: The mean age was 48.9 ± 19.2 years; 70% were male. Generalised convulsive SE was the predominant type (65%). Acute symptomatic aetiology (34%) was the most common category, with cerebrovascular events (cerebral venous thrombosis 14%, stroke 2%) and CNS infections being frequent. The mean GCS at presentation was 7.1 ± 3.2; 60% required intubation. Mean STESS was 1.8 ± 0.8, with 84% in the favourable STESS group (≤3). Polypharmacy (>2 ASMs) was required in 80%, and 48% received midazolam infusion. Poor functional outcome (mRS 3–6) occurred in 64% of patients. Age >65 years (p = 0.024), absence of prior epilepsy (p = 0.036), need for intubation (p = 0.017), lower haemoglobin (p = 0.009), and lower serum potassium (p = 0.035) were significantly associated with poor outcome. Conclusion: SE in this cohort carried a high burden of poor functional outcome, driven largely by advanced age, acute symptomatic aetiologies, depressed sensorium requiring airway support, and biochemical derangements. De novo SE without prior epilepsy was particularly ominous. Early recognition, aggressive treatment of underlying aetiology, and correction of metabolic abnormalities are essential to improving outcomes in resource-limited tertiary care settings.