Status epilepticus in epileptic patients. Related syndromes, precipitating factors, treatment and outcome in a video-EEG population-based study

Introduction: Status epilepticus (SE) is frequently observed in epileptic patients. We reviewed a series of video-EEG documented SE to define the characteristics of SE in this population. Materials and methods: Retrospective evaluation of 50 epileptic patients with SE, revision of the electro-clinical data and therapies, and definition of the semeiological subtypes, aetiology, outcome and related epileptic syndromes. Results: We identified 28 convulsive (19 focal and 9 generalized) and 22 non-convulsive (8 focal and 14 generalized) SE patients. In 13 patients, SE was situation-related (poor compliance, AED reduction, worsening seizures). In the remaining 37 patients, SE was related to the natural history of epilepsy (progression of underlying pathologies or intrinsic expression of epileptic syndromes); in these last cases, our results show a higher occurrence in cryptogenic frontal epilepsy (p = 0.01). We identified two subgroups according to the duration of the event, i.e. SE lasting <12 h and SE lasting >12 h. Our results showed a worse response to therapy in SE lasting >12 h (p = 0.01), a better response to therapy in non-convulsive SE than in convulsive SE (p < 0.05) and a relationship at statistical significance limit between a poor response to therapy/worse outcome and symptomatic epileptic syndromes (p = 0.06). Conclusion: SE in epileptic patients has a wide spectrum of electro-clinical features. It may be related to the withdrawal or reduction of AEDs, or may even be the expression of the evolution of epileptic syndromes. Response to therapy is dependent on early diagnosis and therapy. © 2008 British Epilepsy Association.