Abstracts

RATIONALE: At the end of this activity, the participants should be able to discuss the incidence of status epilepticus as the initial presenting symptom of epilepsy.
Status epilepticus (SE) may cause epilepsy since 40% of generalized convulsive status epilepticus (GCSE) patients later develop epilepsy and epilepsy can be induced by experimental SE; however the frequency with which epilepsy presents with SE is not well studied. We hypothesized that SE is the initial presenting symptom of epilepsy in a substantial minority of patients. Since experimental SE can induce partial epilepsy, we hypothesized that partial epilepsy syndromes, especially temporal lobe epilepsy, are more likely to present with SE.
METHODS: Patients with definite epilepsy seen in the Epilepsy Clinic between 1/1/01 and 12/31/01 were identified from the University of Virginia Comprehensive Epilepsy Program patient database. Patients with only unclassified spells or only pseudoseizures were excluded. The database was queried to determine whether or not an episode of SE had been reported, and to determine demographic, seizure, and epilepsy syndrome characteristics. Phone contact or chart review was attempted to confirm the information contained in the database, including whether the recorded episode of SE occurred (defined as [gt] 30 min of seizure activity), clinical type of SE, SE duration, and whether the episode represented the patient[ssquote]s initial seizure. Chi square analysis was performed to determine whether there was a difference in the frequency of SE as the presenting seizure between patients with partial and generalized seizures and among specific epilepsy syndromes.
RESULTS: Of 786 patients derived from query of the database, we found 157 (20.0%) had a reported history of SE. The history of SE was confirmed in 107, unable to be confirmed (unreachable for confirmation) in 40, denied in 8, and unknown in 2. 125 (15.9%) had at least one episode of GCSE and 43 (5.5%) had at least one episode of nonconvulsive status epilepticus (NCSE). SE as first seizure was present in 26% of those with GCSE and 26% of those with NCSE. Average SE duration was longer for NCSE than GCSE (390 min. vs. 111 min., p=0.003). SE was the first clinical seizure in 42 (5%) and was not different between seizure classes (partial only, generalized only, or both). Among well represented epilepsy syndromes, SE was the initial presentation of epilepsy most frequently in TLE (7.3%) and least frequently in idiopathic generalized epilepsies ( [lt]3%).
CONCLUSIONS: SE is frequently present at the onset of epilepsy. TLE is the syndrome most likely to present with SE, possibly because SE causes TLE. SE is rarely the first seizure in IGE, probably because it is the first manifestation of an already epileptic brain in these patients.