Prompt Treatment Following Status Epilepticus may Prevent Seizure Recurrence

The researchers' team led by Marc Rodrigo-Gisbert analyzed data from a prospective registry of SE episodes in adult patients from February 2011 to April 2022. Out of 849 registered patients, 360 with a first SE episode and without a prior epilepsy diagnosis were included in the study. The median age of the patients was 68 years, and nearly half of them were women.

• A comprehensive study involving 849 patients has shed light on the long-term consequences of status epilepticus (SE) and the potential risk factors for seizure recurrence.
• After excluding in-hospital mortality (23.3%) and patients with prior epilepsy history (44.7%), the analysis focused on 360 patients (42.4%) experiencing their first SE episode.
• The median age of the participants was 68 years, with a range of 56 to 79 years (interquartile range [IQR]). Among the included patients, 48.9% were women.
• The median time to initiate first-line treatment was 2 hours, with an IQR of 0.7 to 7.4 hours. This duration was found to be correlated with the duration of SE (R = .375, p < .001).
• During a median follow-up of 1.8 years (IQR: 0.5-4.3 years), 109 patients (30.3%) experienced unprovoked seizures.
• The researchers conducted a multivariable Cox regression analysis, adjusting for identifiable confounders, and identified several significant risk factors for seizure recurrence.
• Progressive symptomatic etiology was associated with a hazard ratio (HR) of 1.97 and a 95% confidence interval (CI) of 1.17–3.33 (p = .011).
• Time to first-line treatment initiation exceeding 1.5 hours carried an HR of 1.89 and a 95% CI of 1.25–2.87 (p = .003).
• Additionally, super refractory SE was independently associated with a greater risk of seizure recurrence, with an HR of 2.34 and a 95% CI of 1.26–4.33 (p = .007).
• Older patients had a lower risk of unprovoked seizure recurrence, with an HR of 0.99 and a 95% CI of 0.97–0.99 (p = .021). Similarly, individuals with an acute symptomatic etiology exhibited a lower risk, with an HR of 0.44 and a 95% CI of 0.28–0.68 (p < .001).

The study highlights the significance of addressing the underlying cause of SE, ensuring timely treatment initiation, and managing super refractory SE to reduce the risk of subsequent unprovoked seizures. By identifying these risk factors, healthcare professionals can develop appropriate management strategies to prevent seizure recurrence and improve long-term outcomes for patients with SE.

Further research is needed to better understand the underlying mechanisms and develop targeted interventions to prevent seizure recurrence in patients with SE.

Reference:

Rodrigo-Gisbert, M., Gómez-Dabó, L., Quintana, M., Campos-Fernández, D., Lallana, S., Fonseca, E., Abraira, L., Toledo, M., & Santamarina, E. (2023). Prediction of long‐term unprovoked seizures after status epilepticus. Epilepsia. https://doi.org/10.1111/epi.17697