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Outcome predictors for status epilepticus—what really counts

Abstract

In adult patients with status epilepticus (SE)—a life-threatening state of ongoing or repetitive seizures—the current evidence regarding outcome prediction is based on clinical, biochemical and EEG determinants. These predictors of outcome involve clinical features such as age, history of prior seizures or epilepsy, SE aetiology, level of consciousness, and seizure type at SE onset. The clinical risk–benefit calculation between the danger of undertreated persistent seizure activity and, conversely, the potential damage from unwarranted aggressive treatments remains a constant challenge. Improved knowledge of outcome determinants, as well as increased availability of reliable outcome prediction models early in the course of SE, is paramount for optimization of treatment of patients who develop this disorder. In this Review, we discuss the major prognostic determinants of outcome in SE. Through consideration of studies that provide measures of association between predictors of SE outcome and death, we propose a detailed—but as yet unvalidated—paradigm for assessment of these predictors during the course of SE. Such an algorithm could guide the organization of results from existing trials and provide direction with regard to the parameters that should be monitored in future studies of SE.

Key Points

  • The most reliable clinical determinants for early prediction of outcome in status epilepticus (SE) are age, prior seizures or epilepsy, SE aetiology, level of consciousness, and seizure type at onset

  • These variables have been integrated and validated in a clinical scoring system (the Status Epilepticus Outcome Score) for rapid outcome prognostication at SE onset

  • The current outcome score for SE does not encompass the totality of aetiological, biochemical and EEG characteristics—factors that interact in a complex manner and show promise for outcome prognostication

  • On the basis of the available data, we propose a detailed—but as yet unvalidated—paradigm for the assessment of outcome predictors during the course of SE

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Figure 1: Odds ratios of the most studied risk factors for death in SE.
Figure 2: An algorithm for assessment of outcome predictors over the course of SE.

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Acknowledgements

R. Sutter is supported by the Research Funds of the University of Basel, the Scientific Society Basel, and the Gottfried and Julia Bangerter-Rhyner Foundation. P. W. Kaplan receives funding from the Qatar Research Foundation for continuous EEG monitoring in status epilepticus.

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R. Sutter wrote the article. All authors researched data for the article, and provided substantial contribution to discussions of content, and to the review and/or editing of the manuscript before submission.

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Correspondence to Raoul Sutter.

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S. Rüegg has received unconditional research grants from UCB; honoraria for serving on the scientific advisory boards of Eisai and UCB; travel grants from GlaxoSmithKline, Janssen-Cilag and UCB; and speaker fees from UCB; and has served as a consultant for Eisai, GlaxoSmithKline, Janssen-Cilag, Pfizer, Novartis and UCB. The other authors declare no competing interests.

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Supplementary Table 1

Evidence for important determinants of outcome in adults with status epilepticus (DOC 78 kb)

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Sutter, R., Kaplan, P. & Rüegg, S. Outcome predictors for status epilepticus—what really counts. Nat Rev Neurol 9, 525–534 (2013). https://doi.org/10.1038/nrneurol.2013.154

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