Why does status epilepticus cause death

In children, the main cause of status epilepticus is an infection with a fever. In adults, the common causes include:. Your healthcare provider may also order an electroencephalogram.

This involves placing painless electrodes onto your scalp to measure the brain's electrical activity. You may need other tests to search for possible causes. These include a lumbar puncture spinal tap to look for signs of infection. The healthcare provider will want to end the seizure as quickly as possible and treat any underlying problems that are causing it. You may receive oxygen, have blood tests, and an intravenous IV line.

You may be given glucose sugar if low blood sugar may be causing the seizure. Complications depend on the underlying cause and can range from no complications to death. If the underlying cause, such as poor epilepsy control, can be fixed, there may no complications. If the underlying cause is a stroke or brain injury, complications may include physical disability from the cause or even death. If you have epilepsy, taking your medicines as directed may help you avoid status epilepticus.

Avoiding other causes of this condition, such as alcohol abuse or low blood sugar, may also help prevent it. Health Home Conditions and Diseases. This condition can occur as: Convulsive status epilepticus. Status epilepticus with convulsions may be more likely to lead to long-term injury.

Convulsions may involve jerking motions, grunting sounds, drooling, and rapid eye movements. In middle-aged adults, single, unprovoked episodes of status are common; later in life, stroke is a common cause. In all cases, prompt treatment is the key to preventing serious outcomes. The goal of treatment is to stop the seizure activity as quickly as possible and treat any underlying precipitant. Mortality in children and adults is minimized when status lasts less than one hour.

Any type of epileptic seizure can progress to status epilepticus, but convulsive status has the greatest potential for long-term damage. Nonconvulsive status includes continuous absence seizures and partial status epilepticus, including status involving simple partial seizures called epilepsia partialis continua. Nonconvulsive status can present in various ways, including loss of speech, automatisms, and alteration of consciousness.

While not generally viewed as being as damaging as convulsive status, nonconvulsive status involves repeated excessive electrical discharges in the brain and should also receive prompt treatment.

Hospital treatment of convulsive status epilepticus generally includes use of such drugs as diazepam, lorazepam, phenytoin and phenobarbital, administered in a planned sequence. Rectal diazepam gel and a diazepam nasal spray may be prescribed for at-home or non-hospital use to stop bouts of prolonged seizures or clusters of acute repetitive seizures in people with a history of this type of seizure. Data between the fiscal years of and October 1, to September 30, were used and followed up for 1 year until September 30, Patients were eligible for inclusion in this study if their data were in the Thai Universal Coverage Scheme database and they were admitted to hospitals with a primarily diagnosis of SE based on the guidelines described in the International Statistical Classification of Diseases and Related Health Problems — 10th Revision ICD code G41 Status epilepticus.

The SE diagnosis was followed by the guideline of the International League Against Epilepsy in each version over past 10 years. There were no restrictions based on age, sex, or SE type. Patients with incomplete data regarding their date of birth, date of admission, date of death, or cause of death were also excluded. Competing risks events were senility, cardiovascular collapse, etc. Additional file 1 : Table S1 provides the details regarding event of interest and competing events in this study.

Patients who were still alive at the end of the study September 30, were censored data. Predictors in this study included baseline demographic characteristics sex and age at first admission , comorbidities, and complications occurred during the follow-up period. The eligible study subjects were randomly split into a derivation set and a validation set at a ratio.

Characteristics of patients in both sets were reported as frequency and percentage for categorical data and median with minimum and maximum value for continuous data. A sub-distribution hazard function was used to develop a predictive model with competing risks [ 15 , 16 ]. Sensitivity analysis was performed based on selection algorithms, and the modified Bayesian information criterion for competing risks was used to select predictors for the final model [ 17 ].

The coefficients in the final sub-distribution hazard model were used as a scoring system that followed by the method of Austin [ 14 ].

Although the concordance index c-index has been widely used to evaluate the performance of predictive models with time-to-event outcomes, the c-index tends to be misleadingly high when used to predict t-year risk. Thus, we deemed the time-dependent receiver operating characteristic ROC curve to be more appropriate to assess differences at each year point [ 18 , 19 ].

Of the remaining 20, SE patients, 13, were randomly allocated to the derivation set and to the validation set Fig. Characteristics of patients in the derivation set and those in the validation set were comparable Table 1. After application of the forward or backward stepwise procedure, nine predictors remained relevant in the final model Table 2. Of the nine predictors included in the final model, age at first admission, a continuous predictor, was classified into age categories at five-year intervals Table 3.

After following the steps required for the point-based scoring system, scores were assigned to all predictors. The possible total score ranged from zero to 64 Table 4.

The total score was used to determine the probability of event occurrence based on the cumulative incidence function for each year point Table 5. The AUCs in the derivation set were 0. In the validation set, the AUCs for each year from years one to 10 were 0. This study developed and internally validated a new year prediction score for mortality in SE patients after their first admission using a competing risks approach. This simple prediction risk score relied on demographic data, comorbidities, and complications age, sex, brain tumor, stroke, cancer, diabetes, chronic kidney disease, pneumonia, and urinary tract infection.

These finding should be considered with caution, because this study focused on the long-term mortality outside hospital , we cannot guarantee that the indirect causes of death accident, suicide, SE complication, and comorbidity were due to SE.

Similarly, brain tumor, stroke, diabetes, and chronic kidney disease have been identified as predictors using the EMSE [ 9 ]. Because this study focused on long-term mortality in SE patients, gender, cancer, pneumonia, and urinary tract infection scores differed from those found in previous studies. However, prior articles have found clear associations between these predictors and mortality in SE patients [ 4 , 6 , 7 , 24 ], except the urinary tract infection which shown as a protective factor in previous study [ 7 ].

Second, as the database contains the information of patients in all age ranges, the score we developed can be generalized to SE patients of all ages. Lastly, the Universal Coverage Scheme database is connected to that of the Ministry of the Interior, which allowed us to follow up on all patients. However, the death of patients in this study is out-of-hospital mortality. If the patients died with natural causes, the definitive cause of death would not be identified because they were not performed by autopsy, even so, the sensitivity analysis found that the AUCs of first to last time points ranged from 0.

Furthermore, most of the healthcare units lacked the capability to perform EEG difficult to specify the type of seizure. Therefore, most of patients in this study were diagnosed with convulsive SE and our study included all type of SE in order to avoid misclassification of SE types which be lead to underestimation or overestimation.

Moreover, the database did not contain information about duration of seizure and etiology, which are the important predictors associated with death in SE patients. Thus, further studies should include seizure types, duration of seizure, and etiology as predictors.

In addition, we lacked of external validation due to this database containing insufficient longitudinal data. Therefore, external validation should be performed in order to evaluate the generalizability of this study. In this study, we developed the first simple clinical scoring system that considers competing risks to predict long-term mortality after first admission in SE patients. The score is based on demographic data, comorbidities, and complications age, sex, brain tumor, stroke, cancer, diabetes, chronic kidney disease, pneumonia, and urinary tract infection.

The AUCs of the first to last time point ranged from 0. This user-friendly score requires only simple information of patient that contained in the medical records; where clinical or laboratory data was not available. In addition, the risk score can assist the patients to realize their own risk and helps clinicians in their decision-making process about long-term plan for treatment or reduce risk of death, especially patients with high risk.

Although this score can assist in the estimation of a prognosis in an individual patient after discharge as well as SE management, it still needs improvement and external validation. The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

Status epilepticus-related etiology, incidence and mortality: a meta-analysis. Epilepsy Res. Article Google Scholar. The causes of epilepsy : common and uncommon causes in adults and children. New York: Cambridge University Press; Google Scholar. Causes of status epilepticus. A national database of incidence and treatment outcomes of status epilepticus in Thailand. Int J Neurosci. Mortality and recovery from refractory status epilepticus in the intensive care unit: a 7-year observational study.

Mortality following status epilepticus in persons with and without epilepsy. Group on behalf of IER.