Authors :
Presenting Author: Kateriine Orav, MD – Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria; North Estonia Medical Centre, Tallinn, Estonia
Pilar Bosque-Varela, MD PhD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Lukas Machegger, MD, PhD – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Nicolas Jannone-Pedro, MD – University and Polytechnic La Fe Hospital, Member of the European Reference Network EpiCARE, Valencia, Spain
Johannes Pfaff, MD – Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
Eugen Trinka, MD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Giorgi Kuchukhidze, MD, PhD – Christian Doppler University Hospital, Member of the European Reference Network EpiCARE, and Centre for Cognitive Neuroscience, Paracelsus Medical University, Salzburg, Austria
Rationale:
Status epilepticus (SE) is a common neurological emergency with possible long-term consequences. Animal studies have provided evidence that epileptogenesis is a continuous process even after the development of seizures. Some clinical studies suggest that epilepsy, in particular temporal lobe epilepsy, may also follow a progressive course. It is unknown whether SE affects epilepsy progression. This study evaluated whether the occurrence of SE leads to a worsening of seizures and the development of drug-resistant epilepsy (DRE) in people with epilepsy.
Methods:
Adult patients with SE were prospectively recruited at the Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria, between February 2019 and April 2024. Patients with a previous diagnosis of epilepsy and a first lifetime episode of SE were included. Patients were excluded for the following reasons: follow-up < 1 year (n=44), residence outside of the Salzburg district (n=22), patient died in acute phase (n=23), diagnosis of epileptic encephalopathy (n=7).
The outcome was assessed through a retrospective review of digital in- and outpatient hospital records. Follow-up data were acquired until May 16th, 2025. Seizure worsening was defined as a more than 100% increase in the number of seizures during one year after SE compared to one year before or recurrence of SE. DRE was considered if seizures occurred despite the ongoing use of two adequately dosed anti-seizure medicines (ASM). Treatment compliance was taken into account and was evaluated based on chart review and ASM levels at seizure occurrence, if available.
Results:
Sixty-four patients with a previously diagnosed epilepsy and a first episode of SE were identified. The median age was 63.5 (interquartile range 48-72) years and 33/64 (51%) patients were female. Seizure worsening within a year after the first episode of SE was observed in 16/64 (25%) of patients (Figure 1). Prior to the SE episode, 5/64 (8%) patients already had DRE. Among patients with an initially ASM-responsive epilepsy, 15/59 (25%) of patients developed DRE during a median follow-up of 29 (interquartile range 18-41) months after the first episode of SE.
Conclusions:
Patients with epilepsy may experience a worsening of their epilepsy after SE. Whether this association is causal or SE could be a marker of disease progression is unclear and warrants further research.
Funding:
This study was supported by FWF (Austrian Science Fund), project number KLI 969-B.