Early identification of patients at high risk for prolonged status epilepticus (SE), based on clinical characteristics that are readily available at seizure onset, is unreliable; however, timely recognition of patients with a high likelihood of a favorable outcome despite prolonged SE is promising, according to comorbidities, type of SE, and level of consciousness. A 12-year cohort study was conducted at the University Hospital Basel, a Swiss tertiary academic medical care center, with results published in Epilepsia.
The investigators sought to develop prediction models according to readily available clinical parameters to determine prolonged SE at seizure onset and to identify those patients with a high likelihood of a full recovery. All adult patients with SE who were treated at University Hospital Basel between 2005 and 2016 were included in the study. Predictors of prolonged SE (ie, SE for >12 hours, >24 hours, and >48 hours) and return to baseline from prolonged SE were assessed using multivariable Poisson regression.
A total of 467 patients were enrolled in the study. The median participant age was 66.7 years. The mortality rate among those enrolled was 12%. The relative risk (RR) for death was 1.06 with every SE day (P <.0001). According to multivariable analysis, nonconvulsive SE with coma, SE severity score of ≥3, and acute brain lesions at onset of SE were all independent predictors of prolonged SE, with an area under the receiver operating characteristic curve of 0.68 for >12 hours of SE, 0.67 for >24 hours of SE, and 0.72 for >48 hours of SE.
Moreover, absence of nonconvulsive SE with coma (RR 0.22; 95% CI, 0.06-0.84; P =.026) and decreasing Charlson comorbidity index (RR 0.87; 95% CI, 0.77-0.99; P =.044) were both independent predictors of return to baseline in prolonged SE, with area under the receiver-operating characteristic curves of 0.82 and 0.76 after cross-validation. Both associations remained significant in spite of adjustments for determinants of adverse outcomes, including the continuous administration of anesthetics and vasopressors (nonconvulsive SE with coma: RR 0.24; 95% CI, 0.07-0.86; Charlson comorbidity index: RR 0.87; 95% CI, 0.76-0.99).
The investigators concluded that further external validation of their prediction model, according to comorbidities and nonconvulsive SE, is needed before its implementation into clinical practice. Additional research on this topic is thus warranted.
Sutter R, Semmlack S, Kaplan PW, Opić P, Marsch S, Rüegg S. Prolonged status epilepticus: early recognition and prediction of full recovery in a 12-year cohort. Epilepsia. 2019;60(1):42-52.