Validation of a seizure-related injury model.

OBJECTIVE: Persons with epilepsy (PWEs) are more prone to accidents than healthy people. A previous study provided an online tool to predict the risk of seizure-related injury (SRI) in individual PWEs. There is, however, no validation of the formula. METHODS: This is a cross-sectional study conducted in 10 community hospitals in Thailand. PWEs with an age of over 18 years were enrolled and defined by having had a seizure related injury (SRI). The probability of individual PWEs having a SRI was calculated by the online tool (http://sribykku.webs.com). The probability of this happening in all patients was calculated for sensitivity and specificity when compared with real data. RESULTS: There were 316 patients enrolled in the study. Of those, 122 patients (38.6%) had a SRI. The sensitivity and specificity of having a SRI by the online formula were 93.44% and 43.30%, respectively. CONCLUSION: The online formula to predict SRI in PWEs is valid and provided comparable sensitivity and specificity with a previous study that was conducted in the tertiary care hospital.

A national database of incidence and treatment outcomes of status epilepticus in Thailand.

Status epilepticus (SE) is a serious neurological condition. The national database of SE in Thailand and other developing countries is limited in terms of incidence and treatment outcomes. This study was conducted on the prevalence of status epilepticus (SE). The study group comprised of adult inpatients (over 18 years old) with SE throughout Thailand. SE patients were diagnosed and searched based on ICD 10 (G41) from the national database. The database used was from reimbursement documents submitted by the hospitals under the three health insurance systems, namely, the universal health coverage insurance, social security, and government health welfare system during the fiscal year 2010. We found 2190 SE patients receiving treatment at hospitals (5.10/100 000 population). The average age was 50.5 years and 1413 patients were males (64.5%). Mortality rate was 0.6 death/100 000 population or 11.96% of total patients. Significant factors associated with death or a nonimproved status at discharge were type of insurance, hospital level, chronic kidney disease, having pneumonia, having shock, on mechanical ventilator, and having cardiopulmonary resuscitation. In conclusion, the incidence of SE in Thailand was 5.10/100 000 population with mortality rate of 0.6/100 000 population.

Adjunctive enteral phenobarbital for adult status epilepticus: a brief report.

BACKGROUND: Status epilepticus (SE) is a neurological emergency condition. Intravenous phenobarbital (PB) is recommended for refractory SE treatment. However, intravenous PB is unavailable in Thailand. Enteral PB has been shown to be effective in SE children. METHODS: In adult SE patients, the efficacy of enteral PB as an adjunctive therapy has been reported. This is a case series of adult SE patients who were treated with enteral PB at Khon Kaen University Hospital, Thailand. The clinical features and clinical outcomes are reported. RESULTS: There were six patients; five patients had convulsive SE, and one patient had nonconvulsive SE. All patients received PB enterally, at dosages of 900 mg initially and repeated doses of 900 mg as needed. This was gradually reduced to a maintenance dosage of 180 mg/day. Three out of six patients were completely controlled, whereas the other three patients were partially controlled. Three out of six patients were seizure-free after the initial loading dose of PB. No adverse effects were found in this study. CONCLUSION: In adult patients, enteral PB may be effective as an add-on for refractory SE therapy.