Status epilepticus arising de novo in hospitalized patients: an analysis of 41 patients

Most of the information on predisposing factors and mortality in status epi lepticus (SE) arises from data obtained from patients presenting to the cas ualty department. However. another population which is frequently seen by c onsultative neurologists are medically ill patients who develop SE while in hospital. These patients are often notoriously difficult to treat once SE arises. We sought to characterize patients at risk for SE arising when they are hospitalized for other reasons. By doing this, risk factors for develo ping SE and prognostic indicators might be determined. We retrospectively reviewed records from three urban hospitals in the Unite d States to identify hospitalized patients developing SE over a 1 year peri od. SE was defined as a clinical seizure lasting 30 minutes or longer, or r epeated seizures without recovery. Patients who were admitted in SE or for an epilepsy-related problem, or who were less than 1 year old were excluded from the study. Forty-one patients with in-hospital SE were identified. There were 28 males and 13 females with an age range from 1 to 91 years (mean: 60 years, media n: 65 years). The mean interval from hospital admission to the onset of sta tus epilepticus was 26 days. Nineteen (46%) patients had a prior history of either epilepsy or symptomatic seizures, and of these, 10 were inadequatel y treated as judged by serum anticonvulsant levels at the time SE developed . Focal brain abnormality was present in 26 (63%) patients, the most common of which was stroke (17 patients). Major metabolic derangements including hypoxia, electrolyte imbalance, hepatic encephalopathy, and sepsis were pre sent in 23 (56%) patients. Eleven (27%) patients were being treated with th eophylline preparations at the time SE developed. Mortality in this group o f patients with in-hospital SE was 61% (25 deaths), with about one-third dy ing while in status. and two-thirds dying subsequently in hospital. In this retrospective study, there was no clear relationship between mortality and the duration of SE in this group of patients. In-hospital development of SE is usually related to underlying focal brain abnormality, especially stroke, in combination with systemic metabolic dera ngement. Prognosis is poor, and appears to be more related to underlying co nditions rather than to status duration. More accurate prospective studies are warranted. (C) 2001 BEA Trading Ltd.