Status epilepticus in adults: A study from Nigeria

International Journal of Epilepsy - Tập 1 - Trang 69-74 - 2014
Lukman Femi Owolabi1, Aliyu Ibrahim1, Alhassan Datti Mohammed2, Shakirah D. Owolabi3
1Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
2Department of Anesthesiology and Intensive Care, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
3Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria

Tóm tắt

Abstract

Background Status epilepticus (SE) is a common neurologic emergency. Immediate treatment to stop seizure activity and prompt diagnostic evaluation to recognize potentially treatable causes are paramount in the management of SE. Thus, increased awareness of presentation, etiologies, and treatment of status epilepticus SE is central in the practice of critical care medicine. However, there is a paucity of information on SE from Nigeria.

Objective We evaluated the clinical profile and predictors of one-month outcome in a group of Nigerian patients with SE.

Methodology Patients with SE were recruited from the medical, high dependency unit, intensive care unit and accident and emergency departments of a tertiary hospital from 2008 to 2013. The outcome was assessed using Glasgow Outcome Score (GOS). The outcome, which was categorized into dead (GOS = 1) or alive was analyzed in a multivariate logistic regression model.

Result A total of 76 patients was studied. The four most common underlying etiologies were stroke, antiepileptic drug (AED) non-compliance, CNS infections and metabolic derangement. Fifty-nine (77.6%) patients survived. Duration of seizure, delay in initiation of treatment (Odd ratio (OR) = 4.4, 95% CI = 1.17–16.56), refractory status epilepticus (OR = 87.1, 95% CI = 12.94–781.1) were significantly associated with death. On multivariate analysis, however, refractory status epilepticus remained an independent predictor of death.

Conclusion Our study showed that the most common underlying etiologies in SE were stroke, antiepileptic drug non-compliance CNS infections and metabolic derangement. Duration of seizure, delay in treatment and refractory the SE were significantly associated with death, but refractory seizure was an independent predictor of death in SE.


Tài liệu tham khảo

Lowenstein, 1999, Status epilepticus: an overview of the clinical problem, Epilepsia, 40, 3, 10.1111/j.1528-1157.1999.tb00872.x Lowenstein, 1993, Status epilepticus at an urban public hospital in the 1980s, Neurology, 43, 483, 10.1212/WNL.43.3_Part_1.483 Owolabi, 2010, Pattern of neurological admissions in the tropics: experience in Kano, northwestern Nigeria, Ann Indian Acad Neurol, 13, 167, 10.4103/0972-2327.70875 Ogunniyi, 1992, Etiology of status epilepticus in Ibadan: a neuropathologic study, West Afr J Med, 11, 263 Aminoff, 1980, Status epilepticus: causes, clinical features and consequences in 98 patients, Am J Med, 69, 657, 10.1016/0002-9343(80)90415-5 Hauser, 1983, Status epilepticus: frequency, etiology, and neurological sequelae, vol. 34, 3 Cranford, 1979, Intravenous phenytoin in acute treatment of seizures, Neurology, 29, 1474, 10.1212/WNL.29.11.1474 Claassen, 2002, Predictors of functional disability and mortality after status epilepticus, Neurology, 58, 139, 10.1212/WNL.58.1.139 Sagduyu, 1998, Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality, J Neurol, 245, 640, 10.1007/s004150050260 Commission on Classification and Terminology of the International League Against Epilepsy, 1981, Proposal for revised clinical and electroencephalographic classification of epileptic seizures, Epilepsia, 22, 489, 10.1111/j.1528-1157.1981.tb06159.x Hui, 2003, Status epilepticus in Hong Kong Chinese: etiology, outcome and predictors of death and morbidity, Seizure, 12, 478, 10.1016/S1059-1311(03)00024-4 2009, Committee on Protocol for the Management of Medical Emergencies in Aminu Kano Teaching Hospital, vol. 1, 102 Brainin, 2004, Guidance for the preparation of neurological management guidelines by EFNS scientific task forces – revised recommendations 2004, Eur J Neurol, 11, 577, 10.1111/j.1468-1331.2004.00867.x Claassen, 2003, Treatment of status epilepticus: a survey of neurologists, J Neurol Sci, 211, 37, 10.1016/S0022-510X(03)00036-4 Murthy, 2007, Convulsive status epilepticus: clinical profile in a developing country, Epilepsia, 48, 2217 Jennett, 1975, Assessment of outcome after severe brain damage. A practical scale, Lancet, 1, 480, 10.1016/S0140-6736(75)92830-5 Mhodj, 2000, Treatment of status epilepticus in a developing country, Neurophysiol Clin, 30, 165 Towne, 1994, Determinants of mortality in status epilepticus, Epilepsia, 35, 27, 10.1111/j.1528-1157.1994.tb02908.x Ozdilek, 2013, Episodes of status epilepticus in young adults: etiologic factors, subtypes, and outcomes, Epilepsy Behav, 27, 351, 10.1016/j.yebeh.2013.02.023 Tatum, 2001, The etiology and diagnosis of status epilepticus, Epilepsy Behav, 2, 311, 10.1006/ebeh.2001.0195 Treiman, 1984, Subtle generalized convulsive status epilepticus, Epilepsia, 25, 653 Kaplan, 1996, Nonconvulsive status epilepticus, Sem Neurol, 16, 33, 10.1055/s-2008-1040957 Treiman, 2000, Effective treatment for status epilepticus, 253 Li, 2009, Convulsive status epilepticus in adults and adolescents of southwest China: mortality, etiology, and predictors of death, Epilepsy Behav, 14, 146, 10.1016/j.yebeh.2008.09.005 Celesia, 1972, Status epilepticus of late adult onset, Neurology, 22, 1045, 10.1212/WNL.22.10.1047 Owolabi, 2012, Stroke in developing countries: experience at Kano, Northwestern Nigeria, Sudan JMS, 7, 9 Massaro, 2006, Stroke in Brazil: a South America perspective, Int J Stroke, 1, 113, 10.1111/j.1747-4949.2006.00029.x Owolabi, 2013, Profile of stroke-related late onset epilepsy among Nigerians, J Med Trop, 15, 29 Jones, 2003, Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy, Epilepsy Behav, 4, S31, 10.1016/j.yebeh.2003.08.019 Faught, 2008, Non-adherence to anti-epileptic drugs and increased mortality: findings from the RANSOM study, Neurology, 70, 1572, 10.1212/01.wnl.0000319693.10338.b9 DeLorenzo, 1996, A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia, Neurology, 46, 1029, 10.1212/WNL.46.4.1029 Owolabi, 2012, Precipitants of seizure among patients with epilepsy: experience at Kano, Northwestern Nigeria, Sahel Med J, 15, 24 Garzon, 2003, Analysis of clinical characteristic and risk factors for mortality in human status epilepticus, Seizure, 12, 237, 10.1016/S1059-1311(02)00324-2 Maharaj, 1992, Status epilepticus: recent experience at the Port-of-Spain General Hospital, Trinidad, West Indian Med J, 41, 19 Kwong, 1995, Status epilepticus in 37 Chinese children: etiology and outcome, J Paediatr Child Health, 31, 395, 10.1111/j.1440-1754.1995.tb00845.x Koubeissi, 2007, In-hospital mortality of generalized convulsive status epilepticus: a large US sample, Neurology, 69, 886, 10.1212/01.wnl.0000269791.96189.70 Legriel, 2008, Outcomes in 140 critically ill patients with status epilepticus, Intensive Care Med, 34, 476, 10.1007/s00134-007-0915-5 Hesdorfer, 1998, Incidence of status epilepticus in Rochester, Minnesota, 1965–1986, Neurology, 50, 735, 10.1212/WNL.50.3.735 Waterhouse, 1999, Prospective population-based study of intermittent and continuous convulsive status epilepticus in Richmond, Virginia, Epilepsia, 40, 752, 10.1111/j.1528-1157.1999.tb00774.x Coeytaux, 1998, Incidence of status epilepticus in French speaking Switzerland (EPISTAR), Neurology, 50, 735 Owolabi, 2013, Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria, Indian J Crit Care Med, 17, 219, 10.4103/0972-5229.118422