Factores clínicos y epidemiológicos relacionados a mortalidad en pacientes con estatus epiléptico en un hospital de Lima: una serie comparativa de casos / Clinical and epidemiological factors related with mortality in patients with status epilepticus in a general hospital in Lima: a comparative case series

Objetivos: El objetivo del estudio es comparar, entre dos grupos de pacientes, una serie de factores cl¡nico-epidemiol¢gicos relacionados a mortalidad: edad, sexo, comorbilidades, tipo de estatus epil‚ptico y uso deventilaci¢n mec nica. Material y M‚todos: El estudio se realiz¢ en el Hospital Cayetano Heredia entre enero de 2012 hasta diciembre de 2014. Incluy¢ 94 pacientes con el diagnóstico de estatus epil‚ptico admitidos durante el per¡odo establecido. El estudio compar¢ datos de los supervivientes contra datos de los fallecidos. Se recolect¢ la información de las historias cl¡nicas en una ficha de datos para la elaboraci¢n de una base de datos. Resultados: La mortalidad intrahospitalaria fue de 8,51%. La media de edad fue de 41,8 a¤os. Las principales etiolog¡as halladas fueron la epilepsia idiop tica (28,72%), la neurocisticercosis (14,89%) y la enfermedad cerebrovascular(14,89%). Se encontr¢ que un 19,5% de pacientes hab¡an abandonado el tratamiento antiepil‚ptico. El an lisisbivariado demostr¢, para la mortalidad intrahospitalaria, una relaci¢n significativa (p<0,05) con un alto Õndice de Comorbilidad Charlson y el uso de ventilaci¢n mec nica. Conclusiones: La presencia de comorbilidades y el uso deventilaci¢n mec nica se relacionan significativamente con mortalidad en pacientes con estatus epiléptico.

Objectives: The goal of this study is to compare, among two groups of patients, a series of clinical-epidemiologicalfactors related to mortality: age, sex, comorbidity, type of status epilepticus and use of mechanical ventilation.Material and Methods: The study was carried out in the Hospital Cayetano Heredia from January 2012 to December2014. It includes 94 patients with status epilepticus admitted during the established period. The study compareddata from the survivors against data from the deceased. Information from medical records was collected in a Data Sheet to elaborate a data bank. Results: In-hospital mortality was 8.51%. The mean of age was 41,8 a¤os. Themain etiologies found were idiopathic epilepsy (28.72%), neurocysticercosis (14.89%) and cerebrovascular disease(14.89%). It was found that 19.5% of patients had discontinued antiepileptic treatment. Bivariate analysis showed,for in-hospital lethality, a significant relationship (p<0.05) with a high Charlson Index and the use of mechanical ventilation. Conclusions: The presence of comorbidities and the use of mechanical ventilation are significantlyrelated with in-hospital mortality in patients with status epilepticus.

Short-term mortality and prognostic factors related to status epilepticus / Mortalidade a curto prazo e fatores prognósticos de status epilepticus

Objective Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications. .

Objetivos Status epilepticus (SE) está associado com morbidade e mortalidade importantes. Diversos estudos avaliaram determinantes de prognóstico relacionados com SE, havendo controvérsias neste sentido. O objetivo deste estudo foi avaliar mortalidade no SE e seus fatores determinantes. Método Estudo prospectivo, em Ribeirão Preto, incluiu 105 pacientes, entre fevereiro e dezembro de 2000. Mortalidade foi definida como óbito no período de internação hospitalar. Resultados O índice de mortalidade foi de 36.2%, superior ao verificado em estudos prévios. Em análise univariada, mortalidade foi associada com idade, antecedente de epilepsia, presença de crises focais complexas, etiologia, recorrência e refratariedade do SE, presença de complicações clínicas e classificação focal do SE. Em análise multivariada, a ocorrência de complicações clínicas relacionou-se significativamente com prognóstico. Conclusões Em nossa amostra, a mortalidade foi mais elevada do que previamente descrito na literatura, não relacionada com idade, etiologia ou duração do SE, mas, em análise multivariada, com complicações médicas durante o tratamento. .

Higher mortality rate is associated with advanced age and periodic lateralized epileptiform discharges in patients with refractory status epilepticus / Alta taxa de mortalidade está associada com idade avançada e descargas periódicas lateralizadas em pacientes com estado de mal epiléptico refratário

To evaluate clinical data, electroencephalogram, etiology, classification, treatment, morbidity, and mortality in acute refractory status epilepticus. Fifteen patients, mean age of 41.3 years-old, six males, with refractory status epilepticus, were retrospectively studied. All of them were followed by serial electroencephalogram or continuous electroencephalographic monitoring. The most common comorbidity was hypertension. Seven (46.7%) patients were diagnosed with previous symptomatic focal epilepsy. More than one etiology was identified in 40.0% of the cases. Status epilepticus partial complex was the most common (n=14, 93.3%), and discrete seizures were the most observed initial ictal pattern. Continuous intravenous midazolam was used in nine (60.0%) patients and continuous thiopental in three (20.0%). Nine (60.0%) participants died, one (6.6%) had neurological sequelae, and five (33.3%) presented no neurological sequelae. Higher mortality rate was associated with advanced age and periodic lateralized epileptiform discharges. Midazolam proved to be a safe drug. The refractory status epilepticus is related to high mortality. .

Avaliar os dados clínicos, o eletroencefalograma, a etiologia, a classificação, o tratamento, a morbidade e a mortalidade do estado de mal epiléptico. Quinze pacientes, idade média de 41,3 anos, seis masculinos, foram avaliados retrospectivamente. Todos eles foram acompanhados por eletroencefalogramas seriados ou monitoração eletrencefalográfica contínua. A comorbidade mais comum foi hipertensão arterial. Sete (46,7%) pacientes tinham epilepsia focal sintomática prévia. Mais de uma etiologia foi identificada em 40,0% dos casos. O estado de mal epiléptico parcial complexo foi o mais frequente (n=14; 93,3%) e discrete seizures foram os padrões ictal inicial mais observados. Midazolam contínuo foi usado em nove (60,0%) pacientes e tiopental contínuo em três (20,0%). Nove (60,0%) participantes morreram, um (6,6%) teve sequelas neurológicas e cinco (33,3%) não apresentaram sequelas. Alta taxa de mortalidade foi associada com idade avançada e com a presença de descargas periódicas epileptiformes lateralizadas. Midazolam provou ser uma droga segura. Estado de mal epiléptico refratário está associado à alta mortalidade. .

Refractory status epilepticus in children; risk factors, management and early outcome

Refractory status epilepticus is a life-threatening disease in children wherein seizure movements don't response to first line anti convulsion drugs. This study reviewed risk factors, management and early outcome of children with refractory status epilepticus. Patients with refractory status epilepticus admitted in Tabriz children's hospital between 2003 and 2006 were reviewed prospectively for risk factors, management and outcome at time of discharge from hospital. Of the total of 121 patients with status epilepticus, 47 patients [38.8%] were afflicted with refractory status epilepticus. The most common form of refractory status epilepticus was acute symptomatic [38.3%]. Seizure caused by acute symptomatic [RR= 2.36, [CI 95%= 1.25 - 4.44], P=0.006] was a risk factor for refractory status epilepticus development. 87.2% of patients with refractory status epilepticus were treated by midazolam infusion. There was no significant relation between non-response to midazolam, etiology [P=0.798] and type of seizure [P=0.273]. Early outcome of children with refractory status epilepticus was significantly worse than those with status epilepticus [P=0.0001]. About 38% of patients with status epilepticus develop refractory status epilepticus with an increased mortality and morbidity. Seizure caused by acute symptomatic is an important risk factor for developing refractory status epilepticus. In most cases, midazolam infusion results in end of seizure

Status epilepticus: etiology, outcome and predictors of mortality

This study was designed to determine the etiology of status epilepticus [SE] and its relation to mortality. This descriptive study was carried out based on the medical records of 40 patients with diagnosis of SE discharged from pediatric hospital of Bandar Abbas between March 2002 and March 2004. Multivariant analysis was pereformed to determine the prevalence of the disorder and the relation between SE and other factors such as gender, age, response to treatment, and mortality. We classified the etiology according to international league against epilepsy [ILAE] classification and also uses another classification regarding underlying causes such as fever [non-CNS infection], central nervous system infection, hypoxia, and metabolic causes. Status epilepticus was responsible for 0.3% of all hospital admissions during the study period. Based on the ILAE classification, frequencies for acute symptomatic, febrile, progressive encephalopathic, remote, and cryptogenic SE were 42.5%, 32.5%, 10%, 7.5%, and 7.5%, respectively. The most common underlying causes resulting in SE were fever [45%], metabolic disorders [15%], CNS infection [12.5%], chronic neurologic diseases [7.5%], idiopathic [7.5%], hypoxia [5%], drug withdrawal [2.5%], CNS hemorrhage [2.5%], neurodegenerative disease [2.5%], brain abscess [2.5%], and post DPT [Diphteria, Pertusis, Tetanus] vaccination [2.5%]. Mortality rate was 25% [80% in the patients younger than 5 years and 40% in those aged less than 1 year]. Occurrence of SE and its mortality was found to be related to age [p< 0.05]. For SE, if seizures continue for more than 5 minutes, treatment must be initiated. The outcome is determined by etiology, age, seizure duration and management; however, all we can do is enhance the management and increase its effectiveness

Childhood status epilepticus: a study on its etiology, management and early outcome

Status epliepticus is a true medical urgency with high mortality. This study was surveyed etiology, management and early outcome of children with status epilepticus. Patients with status epilpeticus who admitted to emergency ward of Tabriz Children's Hospital between 1381 and 1384 were reviewed cross-sectional and analytical study on seizure type and etiology, its management and outcome at discharge from hospital. Among 123 patients with status epilepticus, 50 patients [40.7%] were afflicted with refractory status epilepticus and 73 patients [59.3%] had non - refractory status epilepticus. The most common etiologies in patients with status epilepticus in order of decreasing frequency were related to be prolonged febrile seizure [40.7%], remote symptomatic [28.4%], acute symptomatic [16.2%] and idiopathic [14.6%]. There was significant correlation between age and etiology [P=0.007]. The most common type of seizure was generalized seizure in 70.7% of patients. The median of duration of status epilepticus was 60 [37-146.25] minutes. In 28 patients [22.7%], diazepam with phenytoin or phenobarbital was used. In 40 patients [32.5%], diazepam with phenytoin and phenobarbital and in 50 patients [40.7%], midazolam were used. In 4 patients [3.25%], thiopental was used. Using midazolam, in 82% of patients with refractory status epilepticus lead to control of seizure. 85.9% of patients returned to their condition before status epilepticus. 8.26% of patients died, and in 5.7% of patients a new neurological sequel was established after status epilepticus. There was statistically significant correlation between patient's outcome and etiology of seizure [p=0.001]. The lowest rate of the mortality and morbidity was seen in prolonged febrile seizure [4%] and the most was in acute symptomatic [45%]. Prolonged febrile seizure was the most common etiology in status epilepticus. The highest mortality rate was seen in patients with acute symptomatic etiology. In most cases, intravenous midazolam infusion terminated the refractory status epilepticus

Status Epilepticus in children: a five-year experience at Aga Khan University Hospital

Status epilepticus is an under diagnosed entity in Pakistan. It is a potentially reversible condition but has a high mortality, if it is not recognized and managed on time. The purpose of this study was to determine the clinical profile and the relationship of mortality of status epilepticus with its known risk factors. This was a retrospective study. Medical records of all the patients admitted in the last five years [19982002] with a diagnosis of status epilepticus [ICDcode 345.30, 345.31] were reviewed. Data was recorded on a Performa and analyzed by using the statistical programme SPSS, chi square and Fischer exact test. The total number of patients were twenty-four. Sixteen patients were males [66.7%]. Mean age was fiftyeight months and mean duration of hospital stay 5.5 days [range 2 to 22 days]. Eight patients were diagnosed to have epilepsy. Four [16.7%] had a previous history of status epilepticus. Three patients presented with status epilepticus for the first time without any previous history of seizures. Ten patients required midazolam infusion [41.7%] and out of these 3 [12.5%] were also given thiopentone infusion to control the seizures. Nine patients were shifted to the ICU for ventilation and control of seizures. Mortality in our study was 25%. Risk factors for mortality included age less than or equal to one year, abnormal MRI, type of the status epilepticus and the total duration of status epilepticus. No significant relationship was found with any of the known risk factors Status epilepticus is a neurological emergency. A very high mortality was seen in our study. No risk factors were identified for this high mortality

Estado de mal epiléptico / Status epilepticus

Se denomina estado de mal epiléptico, a una crisis epiléptica o a una sucesión subintrante de crisis, que persiste por más de 30 minutos, sin volver a un estado de conciencia intercrítico. Es una situación de emergencia, de grave riesgo para la vida y la integridad del cerebro del paciente, por lo que debe emprenderse un tratamiento rápido y eficaz. Este término no sólo incluye las crisis de gran mal, pero es necesario reconocer que las crisis convulsivas tónicos y/o clónicas son las más peligrosas. En el presente artículo se van a revisar los aspectos epidemiológicos, etiológicos, fisiopatológicos, clínicos y de manejo del estado de mal convulsivo

Mortalidade por status epilepticus em hospital psiquiátrico num período de 50 anos (1930-1979) / Mortality by status epilepticus in psychiatric hospital in a period of 50 years (1930-1979)

Por informaçöes obtidas no Serviço de Arquivo Médico e Estatístico do Hospital Juliano Moreira, Bahia, procedeu-se a um estudo descritivo de aspectos epidemiológicos do status epilepticus num período de 50 anos (1930-1979). Foram estabelecidos coeficientes de mortalidade proporcional e analisou-se a distribuiçäo da doença segundo sexo em relaçäo ao ano e década. Os resultados obtidos permitem orientar as seguintes conclusöes: A) Nos primeiros anos após a introduçäo do Luminal observou-se um aumento da mortalidade proporcional vindo a descrever em seguida. B) O sexo masculino é o mais afetado. C) Há uma maior resistência e/ou menor exposiçäo do sexo feminino

Mortalidade por status epilepticus num hospital psiquiátrico durante 50 anos (1930-1979) / Mortality due to status epilepticus in a psychiatric hospital in a period of 50 years (1930-1979)

Através de informaçöes obtidas no Serviço de Arquivo Médico e Estatístico do Hospital Juliano Moreira, Bahia, procedeu-se um estudo descritivo de aspectos epidemiológicos do status epilepticus - num período de 50 anos (1930-1979). Foram estabelecidos coeficientes de mortalidade específica e analisou-se a distribuiçäo da doença segundo sexo em relaçäo ao ano e década. Os resultados obtidos permitem orientar as seguintes conclusöes: a. Nos primeiros anos após a introduçäo do luminal observou-se um aumento da mortalidade específica vindo a decrescer em seguida; b. O sexo masculino é o mais afetado; c. Há uma maior resistência e/ou menor exposiçäo do sexo feminino