Long-term mortality after status epilepticus: A 5-year analysis study.

A Predictive Model for Short-Term Mortality After Status Epilepticus

Background and Objectives Reliable prediction of short-term mortality in status epilepticus (SE) can contribute to guide clinical decisions. Current prognostic systems achieve only acceptable predictive power and show lack of generalizability or poor calibration. We aimed to identify clinical predictors of short-term mortality in patients with nonhypoxic SE and develop a predictive score. Methods This was a multicenter, multinational cohort study based on registry data. Participants were consecutive episodes of SE in participants aged 14 years or older from Modena (Italy) (derivation cohort) and in participants aged 18 years or older from Salzburg (Austria) (validation cohort). The predefined outcome was 30-day mortality after the onset of SE. Age, sex, level of consciousness before treatment, semiology of SE, level of disability at baseline before SE, etiology, and treatment refractoriness were assessed. Adjusted regression coefficients of each independent predictor were transformed to produce a points-based risk scoring system. Results The Italian cohort included 689 episodes, and the Austrian cohort comprised 569 episodes of SE. In the derivation cohort, the 30-day mortality rate was 27.3%. The independent risk factors were aged 75 years or older (odds ratio [OR] 5.52, 95% CI 3.45–8.83; p < 0.001), consciousness impairment (stuporous or comatose) before SE treatment (OR 1.76, 95% CI 1.09–2.82; p = 0.020), acute etiology due to primary CNS pathology (OR 2.60, 95% CI 1.60–4.23; p < 0.001), refractoriness to treatment (OR 6.40, 95% CI 3.91–10.46; p < 0.001), and disability before SE onset (OR 3.53, 95% CI 2.22–5.61; p < 0.001); remote etiology was independently associated with a lower likelihood of 30-day mortality (OR 0.28, 95% 0.13–0.61; p = 0.001). An integer-based scoring system termed Age, Consciousness, Aetiology, Refractoriness, Disability (ACARD) was developed by combining these independent predictors. In the validation cohort, the 30-day mortality rate was 11.6%. The area under the curve of the ACARD score was 0.864 (95% CI 0.836–0.891) in the derivation cohort and 0.845 (95% CI 0.801–0.888) in the validation cohort. Calibration plot indicated good fit of predicted and observed data in both cohorts. Discussion The ACARD score is a user-friendly tool developed to predict 30-day mortality after nonhypoxic SE. It has the potential to identify participants at high risk of short-term mortality and outperform the performance of other available scoring systems.

Three-Year Mortality After First Acute Symptomatic Seizure: A Prospective, Population-Based Study in Ireland.

BACKGROUND AND OBJECTIVES Acute symptomatic seizures (ASyS) are clinical seizures occurring at the time of a systemic insult or in close temporal association with a documented brain injury. We aimed to determine the 3-year mortality following a first ASyS. METHODS We previously conducted a prospective, population-based cohort comprising all individuals with a first seizure during 2017 from a defined geographic area. Individuals with ASyS were identified from this cohort using ILAE criteria and stratified by provoking factor. Mortality was assessed at 30 days, 1 year, and 3 years following the event, and age-standardized mortality ratios (SMRs) were calculated at 1 and 3 years using age-matched and sex-matched national mortality data. RESULTS Among 207 cases of first ASyS, identified from a population of 542,868, there were 61 deaths (29.5%) during 3 years of follow-up. Mortality at 30 days, 1 year, and 3 years was 12.6%, 22.2%, and 29.5%, respectively. The SMR was 19.7 (95% CI 14.4-26.3) at 1 year and 10.4 (95% CI 7.9-13.4) at 3 years. Mean age at first ASyS was 52.1 years and at death 70.5 years. Excluding the substance use group, 3-year mortality rose to 45.5% (50/110). Pneumonia was the most frequent cause of death (17/61, 27.9%). DISCUSSION ASyS is a common presentation and is associated with markedly increased mortality over 3 years. These findings underscore the prognostic importance of ASyS as a clinical indicator of increased long-term mortality, particularly in medically complex patients.

Determinants of progression to refractory status epilepticus in low- and middle-income countries: A retrospective single-center analysis of treatment timing.

BACKGROUND Status epilepticus (SE) is a neurological emergency associated with high morbidity and mortality. Benzodiazepines (BZDs) are recommended as first-line treatment within minutes of seizure onset; however, treatment delays remain common, particularly in low- and middle-income countries, where data regarding determinants of refractory status epilepticus (RSE) are limited. METHODS We conducted a retrospective single-center cohort study including consecutive patients aged ≥ 16 years with SE. The primary objective was to identify factors associated with progression to RSE, with particular focus on latency to first BZD administration. Multivariable logistic regression analysis was performed. RESULTS A total of 109 SE episodes were analyzed, of which 62 (56.9 %) progressed to RSE. Early BZD administration (≤30 min) occurred in 34.9 % of cases, whereas latency was undocumented in 14.7 %. Early treatment was more frequent in non-RSE than RSE episodes (48.9 % vs 24.2 %), while unknown latency was more common in RSE cases than non-RSE (22.6 % vs 4.3 %; p < 0.01). Two multivariable models were built, differing in how time to BZD was coded. In Model 1 (three-level time-to-BZD variable), undocumented latency was associated with RSE (OR = 9.3, 95 %CI:1.77-49.0; p = 0.01); administration beyond 60 min (OR = 2.4, 95 % CI:0.91-6.63; p = 0.09) and acute symptomatic etiology (OR = 2.2, 95 %CI:0.96-5.0; p = 0.06) were not. In Model 2 (dichotomized time-to-BZD), acute symptomatic etiology was independently associated with RSE (OR = 2.3, 95 %CI:1.05-5.22; p = 0.04). CONCLUSIONS Undocumented latency to BZD administration and acute symptomatic etiology were independently associated with RSE, highlighting challenges of timely SE recognition and supporting efforts to standardize treatment pathways in resource-limited settings.

Long-term prognostic value of early post-operative electroencephalogram in patients with drug-resistant temporal lobe epilepsy associated with hippocampal sclerosis.

High-frequency IEDs on early postoperative EEG may identify patients at increased risk of long-term deterioration after surgery for HS-related TLE, and prospective studies are needed before modifying routine follow-up strategies.

Management Challenges and Clinical Characteristics of Refractory Status Epilepticus in Mexico: A 102 Patient Retrospective Cohort Study.

Predictive Performance of STEPSS in Pediatric Status Epilepticus

Abstract Objectives To evaluate the predictive performance of the Status Epilepticus in Pediatric Patients Severity Score (STEPSS) in predicting short-term functional outcomes in children presenting with status epilepticus (SE). Methods This ambispective study was conducted in a tertiary pediatric intensive care unit over 18 months. Seventy-six children, aged 1 month to 18 years, presenting with SE, were enrolled. The STEPSS was calculated at admission. This scoring system was adapted from prior pediatric studies with appropriate permissions. It encompasses factors such as consciousness, seizure type, age, and a history of previous seizures. Outcomes were assessed using the Pediatric Overall Performance Category (POPC) scale at discharge and 3-month follow-up. The predictive ability of STEPSS was evaluated using sensitivity, specificity, and receiver operating characteristic analysis. Results Of the 76 patients, 36 (47%) had an acute, symptomatic etiology. The median STEPSS was 2 (interquartile range: 1–3), with 36.8% of participants having a score greater than 2. Poor neurological outcomes (POPC scores >2) were noted in 31 (40.8%) children at discharge and 25 (33.7%) at follow-up. STEPSS >2 predicted unfavorable outcomes both at discharge and at 3-month follow-up. STEPSS >2 predicted poor outcomes at discharge with an area under the curve of 0.760 (95% confidence interval: 0.65–0.82, p  < 0.001), yielding 75% accuracy, 64% sensitivity, 82% specificity, positive predictive value of 71%, and a negative predictive value of 77%. Conclusion The STEPSS >2 shows a moderate predictive performance of functional outcomes in children with SE at discharge and at 3-month follow-up, with clinically useful sensitivity and specificity. This tool can provide insight for management and may serve as a practical bedside tool.