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      Evaluation of Short-term Mortality of Status Epilepticus and Its Risk Factors

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          Abstract

          Background and Purpose:

          Status epilepticus (SE) is defined as epileptic seizures of greater than five minutes or more than one seizure within a five minute period without returning to normal consciousness between them. It is a life-threatening condition particularly if treatment is delayed. Previous studies reported age, duration and etiology of SE as primary determinants of mortality.

          Methods:

          This prospective cross-sectional study performed on the patients with status epilepticus admitted in Rasoul-e-Akram hospital in Tehran. Patients followed at 30th day after SE to assess their living status.

          Results:

          Sixty-five patients, (56.9% was male) with 15 to 88 years of age entered the study. Mean duration of SE was 40 minutes and for hospital stay was 7 days. 84.6% of patients responded to treatment and 11 patients (16.9%) died within 30 days after SE. Mortality rate in patients with refractory SE was 70%. Mean interval between SE and death was 11.9 ± 11.7 days. Age, duration of SE and hospital stay, history of head trauma and neurosurgery were not predictors of mortality. Negative history for epilepsy had significantly higher mortality rate. Anoxic encephalopathy increased the mortality rate and response to treatment decreased it.

          Conclusions:

          Short-term mortality rate of SE was comparable with most of the previous reports Since our hospital has equipped emergency department, resuscitation and primary treatment of SE is usually start soon, percentage of anoxic encephalopathy is decreased and lower mortality rate is expected. We conclude that early treatment by decrease chance of anoxic encephalopathy, has significant role in outcome of SE.

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          Most cited references16

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          A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group.

          Although generalized convulsive status epilepticus is a life-threatening emergency, the best initial drug treatment is uncertain. We conducted a five-year randomized, double-blind, multicenter trial of four intravenous regimens: diazepam (0.15 mg per kilogram of body weight) followed by phenytoin (18 mg per kilogram), lorazepam (0.1 mg per kilogram), phenobarbital (15 mg per kilogram), and phenytoin (18 mg per kilogram). Patients were classified as having either overt generalized status epilepticus (defined as easily visible generalized convulsions) or subtle status epilepticus (indicated by coma and ictal discharges on the electroencephalogram, with or without subtle convulsive movements such as rhythmic muscle twitches or tonic eye deviation). Treatment was considered successful when all motor and electroencephalographic seizure activity ceased within 20 minutes after the beginning of the drug infusion and there was no return of seizure activity during the next 40 minutes. Analyses were performed with data on only the 518 patients with verified generalized convulsive status epilepticus as well as with data on all 570 patients who were enrolled. Three hundred eighty-four patients had a verified diagnosis of overt generalized convulsive status epilepticus. In this group, lorazepam was successful in 64.9 percent of those assigned to receive it, phenobarbital in 58.2 percent, diazepam plus phenytoin in 55.8 percent, and phenytoin in 43.6 percent (P=0.02 for the overall comparison among the four groups). Lorazepam was significantly superior to phenytoin in a pairwise comparison (P=0.002). Among the 134 patients with a verified diagnosis of subtle generalized convulsive status epilepticus, no significant differences among the treatments were detected (range of success rates, 7.7 to 24.2 percent). In an intention-to-treat analysis, the differences among treatment groups were not significant, either among the patients with overt status epilepticus (P=0.12) or among those with subtle status epilepticus (P=0.91). There were no differences among the treatments with respect to recurrence during the 12-hour study period, the incidence of adverse reactions, or the outcome at 30 days. As initial intravenous treatment for overt generalized convulsive status epilepticus, lorazepam is more effective than phenytoin. Although lorazepam is no more efficacious than phenobarbital or diazepam plus phenytoin, it is easier to use.
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            Predictors of outcome in refractory status epilepticus.

            To further characterize the demographics, outcomes, and prognostic factors for refractory status epilepticus (RSE).
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              Causes of status epilepticus.

              Status epilepticus (SE) is the most extreme form of epilepsy. It describes a prolonged seizure that may occur in patients with previous epilepsy or in acute disorders of the central nervous system. It is one of the most common neurologic emergencies, with an incidence of up to 41 per 100,000 per year and an estimated mortality is 20%. The three major determinants of prognosis are the duration of SE, patient age, and the underlying cause. Common and easily recognized causes of SE include cerebrovascular disorders, brain trauma, infections, and low antiepileptic drug levels in patients with epilepsy. Less common causes present a clinical and diagnostic challenge, but are major determinants of prognosis. Among them, inflammatory causes and inborn errors of metabolism have gained wide interest; recent insights into these causes have contributed to a better understanding of the pathophysiology of SE and its appropriate treatment. This review focuses on the different etiologies of SE and emphasizes the importance of prompt recognition and treatment of the underlying causes. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.
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                Author and article information

                Journal
                J Epilepsy Res
                J Epilepsy Res
                ER
                Journal of Epilepsy Research
                Korean Epilepsy Society
                2233-6249
                2233-6257
                June 2015
                30 June 2015
                : 5
                : 1
                : 13-16
                Affiliations
                [1 ]Rasool Akram Hospital Neurology, Iran University of Medical Sciences, Tehran, Iran;
                [2 ]Medical Intern, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran;
                [3 ]Associate Prof. of Neurology, Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
                Author notes
                Corresponding author: Elham Ataei, Elham Ataei, Assistant of Neurology, Rasool Akram Hospital, Iran University of Medical Sciences. Tehran, Iran, Tel. +98-21-6435-2496, Fax. +98-21-6651-7118, E-mail; eliata1360@ 123456yahoo.com
                Article
                er-5-1-13
                10.14581/jer.15003
                4494989
                26157668
                723ea585-edfc-4203-a113-89b809900f30
                Copyright © 2015 Korean Epilepsy Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 December 2014
                : 28 February 2015
                Categories
                Original Article

                status epilepticus,mortality rate,refractory seizure

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