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Category: Volume 07 Issue 01 January 2019
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Title: Determinants of Outcome in Convulsive Status Epilepticus in Adults: An Ambispective Study

Authors: Dr I. D. Chaurasia, Dr Prateek Malpani, Dr Neeraj Mane, Dr Vijay Nandmer, Dr M. C. Songara

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.28

Abstract

 

Background: Ours is an ambispective observational study conducted in the Department of Neurosurgery attached to Gandhi Medical College, Bhopal.

The patients of convulsive SE (cSE), i.e., prolonged or intermittent seizures lasting beyond 5 minutes, without full recovery of sensorium, are admitted to our well equipped (NICU) and treated consecutively as per the departmental cSE treatment protocol adopted and modified from ILAE[1].

Study Designed: Ambispective Observational study

Result: Although the STESS score of >2 was found to be associated with higher odds of poor outcome (OR- 2.52, CI- 0.75-8.4, Table 1). With 55.8% of the patients with STESS>2 getting discharged and 23.9% of those with a score of ≤2 experiencing poor outcome, its ability to identify the unfavorable outcome correctly was poor (AUC 0.62, sensitivity of 75% and specificity of 45.7%).

Conclusion: In conclusion, our study identifies that low MAP, delay of >3.5h in treatment initiation or seizure control are the determinants of poor outcome in cSE. With incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision making and prognostication of patients with cSE

Keywords: Outcome, Convulsive, Epilepticus & Adults. 

References

  1. Trinka E, Kalviainen R. 25 Years of Advances in Definition, Classification and Treatment of Status Epilepticus. SEIZURE: European journal of epilepsy
  2. Nair PP, Kalita J, Misra UK. Why, what, and how. J Postgrad Med.2011;57:242-52.
  3. Sanchez S, Rincon F. Status Epilepticus: Epidemiology and Public Health Needs. J ClinMed.2016;5(8):71.
  4. Kalita J, Nair PP, Misra UK. A clinical, radiological and outcome study of status epilepticus from India. J Neurol 2010;257:224-229.
  5. Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: Clinical profile in a developing country. Epilepsia.2007;48(12):2217-2223.
  6. Bhalla A, Das B, Som R, Prabhakar S, Kharbanda PS. Status epilepticus: Our experience in a tertiary care center in Northwestern India. Journal of Emergencies, Trauma, and Shock. 2014;17(1).
  7. Kalita J, Misra UK, Patel R. Initial EEG in status epilepticus is helpful in predicting seizure recurrence. Electromyogr. clin. neurophysiol.2006;46.
  8. Rossetti AO, Hurwitz S, Logroscino G, Bromfield EB. Prognosis of status epilepticus: role of etiology, age and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry 2006;77:611-615.
  9. Rossetti AO, Logroscino G, Milligan TA, Michaelides C, Ruffieux C, Bromfield EB. Status Epilepticus Severity Score (STESS).J Neurol.2008;255:1561-1566.
  10. Delorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A prospective, population-based epidemic-ologic study of status epilepticus in Richmond, Virginia. Neurology 1996Apr;46 (4):1029-35.
  11. Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study.Epilepsia 2010 Feb;51(2):251-6.
  12. Drislane FW, Blum AS, Lopez MR, Gautam S, Schomer DL. Duration of refractory status epilepticus and outcome: Loss of prognostic utility after several hours. Epilepsia.2009;50(6):1566-1571.
  13. Hassan H, Rajiv KR, Menon R, Menon D, Nair M, Radhakrishnan A. An audit of the predictors of outcome in status epilepticus from a resource-poor country: a comparison with developed countries. Epileptic Disorder.2016;18(2): 163-172.
  14. Towne AR, Pellock JM, Ko D, Delorenzo RJ. Determinants of mortality in status epilepticus.Epilepsia.1994Jan-Feb.

Corresponding Author

Dr Prateek Malpani