Abstracts

Rationale: Epidemiology and clinical characteristics of status epilepticus (SE) in a single tertiary care centre may differ from those in population-based studies. This study evaluates epidemiological, clinical and outcome characteristics of SE at one University Hospital. Methods: Retrospective analysis of epidemiological and clinical data of a cohort of patients (pat) with SE in a tertiary care centre between 10-2002 and 12-2005. The observation period included the time from onset of SE until hospital discharge. Parameters assessed were sex, age, SE duration, SE type, treatment with phenytoin (PHT) or valproate (VPA), SE refractoriness, and hospitalization (hosp) length. Uni- and multivariate analyses of these factors were used to evaluate a dichotomized outcome: a positive outcome was defined as overall survival with response to benzodiazepines (BZD) and i/v VPA or PHT. Results: Hundred and six pat, 53.8% women and 46.2 % men with a mean age 64 y (range:19.7-92.3) had 111 episodes of SE. Hospitalization length was 18 ±15.3 d and mortality 11.3%. There were 18.9% convulsive SE (CSE), 34.2% subtle status (SSE) and 46.9% non-convulsive SE (NCSE). SE was focal in 49.6%, secondarily generalized in 37.8%, and primarily generalized in 12.6%. No sex difference was found for SE type, but hosp was significantly longer in women (22.3 ± 16.0 d) than in men (13.0 ± 13.1 d), p= 0.0013. The median of SE duration was 48 h (range:1-408). Univariate analysis showed that pat >70 years had a significantly higher chance of a positive outcome (OR: 5.135; p=0.0029), pat with a negative outcome were significantly younger (59.4±15.0 vs. 68.3±15.8 y, p=0.0019). Patients with CSE had significantly less frequent negative outcomes than those with SSE or NCSE (p=0.0079). The chance of a positive outcome in pat with SSE was significantly reduced when compared with NCSE (OR: 0.323; p=0.0128). Hospitalization length was significantly increased in presence of a negative outcome (13.9±11.5 vs. 22.0±17.5 d, p=0.0142), whereas SE duration between a positive or negative outcome was borderline significantly different (49.5±52.5 vs. 103.0±116.4 h, p=0.0579). There was no significant difference in outcome between treatment with VPA or PHT (p=0.1344). In a multivariate analysis, young age was a significant risk factor for a negative outcome (OR: 1.037 (1.006-1.069) per 1 year less in age, p=0.0185) as well as SSE when compared to NCSE (OR:3.802 (1.316-10.989), p=0.0137) and to CSE (OR: 3.413 (0.935-12.50), p=0.0631). There was an indication of a higher risk of a negative outcome in pat treated with PHT compared to VPA (OR: 2.59 (0.840-8.00, p= 0.0978)). Conclusions: This retrospective analysis of a cohort of pat with SE at one tertiary care centre showed a preponderance of NCSE and SSE in contrast to epidemiological studies where CSE is the most frequent type of SE. In this hospital setting, age < 50 was associated with a higher risk for refractory SE (RSE), and age > 70 with a higher chance to stop SE with BZD and i/v PHT or VPA. NCSE and SSE carried a higher risk to become RSE.