Authors :
Presenting Author: Jonathan Macias-Lopez, MD – National Institute of Neurology and Neurosurgery
Diego Pichardo-Rojas, MD – Instituto Nacional de Neurologia y Neurocirugia
Sonia Mejia Perez, MD – Instituto Nacional de Neurología y Neurocirugía
Karen Camarena-Rubio, MD – Instituto Nacional de Neurología y Neurocirugía
Oscar Esquivel-Zapata, MD – Instituto Nacional de Neurologia y Neurocirugia
Salvador Martinez-Medina, MD – National Institute of Neurology and Neurosurgery
Pilar Robles-Lomelin, MD – National Institute of Neurology and Neurosurgery
Irene Gomez-Oropeza, MD – Instituto Nacional de Neurologia y Neurocirugia
Elma Paredes-Aragon, MD – National Institute of Neurology and Neurosurgery
Rationale:
Status epilepticus (SE) is a neurological emergency involving seizures lasting over 5 minutes or occurring in rapid succession without recovery, leading to increased risks of neuronal damage, functional impairments, and mortality. Its annual incidence is around 1 in 100,000, with a mortality rate ranging from 20% to 80%, and a higher 1-year mortality rate in adults.
Methods:
In this retrospective cross-sectional cohort, we included patients 18 years old or older with SE recruited over an eight-month period at the National Institute of Neurology and Neurosurgery in Mexico City. We compiled the rate of having an abnormal cerebrospinal fluid (CSF), function outcome at discharge, and intrahospital mortality. Admission severity was calculated with the Status Epilepticus Severity Score(STESS). Functional status at discharge was described using the modified Rankin scale (mRS).
Results:
From June 2023 - February 2024, 756 records were screened and 65 patients met our inclusion criteria. Thirty-three were male (50.8%). The median age was 36 years [IQR 25.5-55.5]. Seventeen (26.2%) patients did not have a history of epilepsy. SE was most frequently caused by infectious diseases (n=24, 36.9%), followed by Anti-Seizure Medication (ASM) discontinuation (n=7, 10.8%), and stroke (n=7, 10.8%). Twenty patients (30.8%) had a history of previous SE. Median hospital length of stay was 3 days [IQR 1-16], with 16 patients (24.6%) requiring admission to the Neurological Intensive Care Unit (NICU). The median NICU stay was 11 days [IQR 4.5-19.75]. In-hospital mortality was reported in 4 patients (6.6%) (See Table 1). Cerebrospinal fluid cellularity was abnormal in 6 (9%) . Forty-six (70.8%) presented with a STESS of 0-2, 12 patients with a STESS of 3 (18.5%), and 7 patients ranging from 4-6 (10.7%). MRS was calculated at discharge: Twenty-nine patients (47.5%) had a significant neurological disability (mRS 3-5), and 29 (47.5%) had a good neurological outcome.
Conclusions:
Status epilepticus is associated with a high rate of neurological disability at discharge, often accompanied by abnormal cellularity on CSF. In our sample, the causes of status epilepticus align with current literature, with infections being the most common. Our case series serves to highlight the high morbimortality associated with status epilepticus in Mexican patients, an underrepresented sample in current literature. More studies on a higher number of patients are required to more adequately evaluate the long term consequences of status epilepticus.
Funding: Self funded.