Convulsive status epilepticus: clinical profile in a developing country.
OBJECTIVE
In developing countries optimal care of status epilepticus (SE) is associated with major barriers, particularly transportation.


METHODS
A prospective study of SE was performed between 1994 and 1996 to determine the clinical profile, response to treatment and outcome, Glasgow Outcome Scale (GOS).


RESULTS
Of the 85 patients admitted, the mean age was 33 years (8-75 years), 16% <16 years of age. The mean duration of SE before admission was 18.02 h (1-72 h). Only 23 (28%) patients, all locals, presented within <3 h of onset. Etiology included acute symptomatic (54%), remote symptomatic (7%), cryptogenic (19%), and established epilepsy (20%). Central nervous system infections accounted for 24 (28%) of the etiologies. Seventy-five (88%) patients responded to first-line drugs and 10 (12%) required second-line drugs. The mean duration of SE was significantly long in nonresponders (Mean +/- SD: 32.6 +/- 20.11 vs. 15.2 +/- 18.32, p < 0.006). Duration (p < 0.01; OR 1.04, 95% CI 1.01-1.07) and acute symptomatic etiology (p < 0.038; OR 10.38, 95% CI 1.13-95.09) were the independent predictors of no-response to first-line drugs. Of the nine deaths (10.5%), eight were in acute symptomatic group. Predictors of mortality included female sex (p < 0.017, OR 13.41, 95% CI 1.59-115.38) and lack of response to first-line drugs (p < 0.0001, OR 230.27, 95% CI 8.78-6037.19). Longer duration was associated with poor GOS 1-4 (p = 0.001). Of the 37 patients with <6 h, 81% had GOC5 outcome.


CONCLUSIONS
This study suggests that longer duration of SE and acute symptomatic etiology are independent predictors of lack of response to first-line drugs. Failure to respond to first-line drugs and duration predict the outcome.
Murthy
Jagarlapudi M K
JM
Department of Neurology, The Institute of Neurological Sciences, CARE Hospital, Hyderabad, India. jmkmurthy@satyam.net.in
Jayalaxmi
Sita S
SS
Kanikannan
Meena A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D003906:Developing Countries; D005260:Female; D023261:Glasgow Outcome Scale; D006760:Hospitalization; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012737:Sex Factors; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000927:Anticonvulsants