First Attack of Status Epilepticus in Adults: Etiology and Risk Factors

Abstract
Background: Status Epilepticus (SE) is a common life-threatening neurological emergency the etiology of SE varies according to age and prior history of seizures. In people known to be epileptic poor compliance and drug withdrawal are the commonest causes of SE. On the other hand in patients with no prior seizure history strokes, head traumas, CNS infections, cardiac arrests and metabolic disturbances are the most com-mon causes.
Aim of Study: Is to study the possible etiologies and outcome of first attack of SE in adults.
Patients and Methods: This was a 6-month duration cross sectional study done at Neuropsychiatry Department, Tanta University Hospital, started from July 2016. All patients presented by first attack of SE over the age of 18 years and didn't have previous history of SE, were considered.
Results: Of 42 patients included in the study 35 (83.3%) had non refractory SE while 7 (16.7%) had RSE. 37 patients survived (88.1%) and 5 patients died (11.9%). Analysis of statistically significant and most clinically important variables showed that these factors were significantly higher in RSE, cryptogenic etiology (p=0.024), EEG changes (p=0.015). number of AEDs (p=0.001), duration of hospitalization (p= 0.037), complications due to hospitalization (p=0.015), EMSE scores (p=0.001).
Conclusion: Most patients presented by SE over the age of 18 has no prior history of epilepsy. CVAs are the leading cause of de novo SE in adults followed by metabolic derange-ments. Refractory Status Epilepticus (RSE) is associated with prolonged duration of hospitalization and higher rates of complications compared to non-refractory SE. Complications due to seizures were the most common followed by side effects of AEDs while complications of prolonged hospitali-zation were the least common. EEG monitoring is an important tool both in managing and predicting the outcome of status epilepticus. STESS and EMSE scoring systems are easy to use bed side tools to help in predicting the outcome of SE.