title: Recurrence of status epilepticus: prognostic role and outcome predictors.
abstract: OBJECTIVE
  Predictors of morbidity and mortality after status epilepticus (SE) have been studied extensively in hospital- and population-based cohorts. However, little attention has been directed toward SE recurrence after an incident episode. We investigated clinical and demographic characteristics of patients presenting SE recurrence and its specific prognostic role.
  
  
  METHODS
  In this observational cohort study, we screened our prospective registry of consecutive adults with SE between April 2006 and February 2014. Demographic and clinical data were compared between incident and recurrent SE episodes; risk of SE recurrence was assessed through survival analysis, and the prognostic role of SE recurrence with multivariable logistic regressions.
  
  
  RESULTS
  Of the incident cohort (509 patients), 68 (13%) experienced recurrent SE. The cumulative recurrence rate over 4 years was 32%. Recurrence risk was significantly reduced after an acute SE etiology (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.31-0.82; p = 0.005), and was borderline increased in women (HR 1.59, 95% CI 0.97-2.65; p = 0.06). Although recurrent SE episodes showed lower morbidity and mortality, prognosis was independently related to Status Epilepticus Severity Score (STESS) and potentially fatal etiology, but not to SE recurrence.
  
  
  CONCLUSIONS
  This study provides class III evidence that SE recurrence involves a significant proportion of patients, and that recurrence risk is independently associated with chronic etiology and to a lesser extent with female gender. However, contrary to underlying cause and SE severity, SE recurrence per se does not independently correlate with outcome. Early identification of patients at higher risk of SE recurrence may influence their management during follow-up.
authors.affiliation: Department of Clinical Neurosciences, University Hospital of Vaud, University of Lausanne, Lausanne, Switzerland.
authors.forename: Spyridoula
authors.initials: S
authors.lastname: Tsetsou
authors.forename: Jan
authors.initials: J
authors.lastname: Novy
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D015331:Cohort Studies; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000927:Anticonvulsants
keywords: Etiology; Female; Gender; Mortality; Prognosis; Risk