Osman, AM; (2007) Incidence, aetiology and morbidity of status epilepticus. Doctoral thesis , UCL (University College London).

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Abstract

Status epilepticus (SE) is a common neuro-medical emergency for which medical institutions should be well prepared as well as at community level. This review considers available epidemiological studies of SE in the last decade (1996-2006) in order to: (a) determine the incidence of status epilepticus as recorded in population and hospital based studies (b) determine the causes of SE as defined in these studies and (c) to ascertain the rates of morbidity, in terms of neurological deficit and continuing epilepsy, of SE._PUBMED search was carried out a total of eleven population based studies and 20 hospital based studies were included. In addition, 10 studies provided sufficient data to be included for the purposes of determining morbidity. Incidences of SE among the studies included are quite different. The incidence rate range between highest 41/100.000/y to lowest 9.9/100.000/y among population based studies. Among hospital based studies incidence of SE varies between highest of 13.1/100.000/y to lowest incidence of 4.9/100.000/y. This difference in the incidence rates among these studies depend on the different case identification methods used. In all epidemiologic studies under ascertainment is the major problem. In addition, an actual change in the frequency of SE over time may exist with the improvement in diagnosis and management of epilepsy. Remarkably, there is considerable consistency across the studies regarding several important features in SE epidemiology. Most of these studies agreed about the bimodal distribution of SE between children less than five years and elderly more than 65years. Another consistency among the different studies is that SE shows slight predominance between male genders (except in two studies which shows slight female predominance). The main cause of SE among children was febrile status epilepticus up to 50%. In comparison the main cause of SE among adults was symptomatic epilepsy up to 40%. Not all SE are attributed to epilepsy, de novo SE is an important category of SE, contributing to almost half of SE cases. Morbidity from SE varies from 35% acute neurologic sequalae to no neurologic deficit recorded at all. Morbidity was associated with age of the patients, symptomatic epilepsy and seizure duration. The incidence of SE is not well established and varies between different studies. SE is an under recognized neurologic emergency that needs more investigation. Consistency between different studies regarding bimodal distribution of SE between elderly and children less than five years. The main aetiology of SE between children was febrile status epilepticus and between adults is symptomatic SE. Morbidity and outcome of SE is a matter of debate, since it may represent the causal of SE rather than the sequalae of it. Further studies are, however, needed to determine accurately the incidence, aetiology and morbidity rates of SE, and if there is any changes in these rates over time.

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