Status epilepticus: caused by missing anticonvulsants or abusing alcohol.

Clinical bottom line (level 4)

  1. The commonest cause of status in patients was failure to take their anticonvulsant medication properly, followed by alcohol and strokes.
Aminoff and Simon: American Journal of Medicine 1980; 69: 657-665
Expires September 2003

The study

Case series with ?objective ?blinded outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital USA

98 patients (aged range 14 to 83 years, 74% male) two or more convulsions (tonic or tonic-clonic) without regaining consciousness in between

Excluded if
  • <14 years old
  • absence (petit mal), myoclonic or partial seizures





    • Outcomes studied:
  • discontinued or irregular anticonvulsant use
  • alcohol-related
  • stroke
  • unknown
  • drug overdose
  • metabolic
  • cardiac arrest
  • cerebral tumour
  • infection
  • trauma

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    discontinued or irregular anticonvulsant use ? 27/98 27%
    (19% to 36%)
    alcohol-related ? 15/98 15%
    (8.2% to 22%)
    stroke ? 15/98 15%
    (8.2% to 22%)
    unknown ? 15/98 15%
    (8.2% to 22%)
    drug overdose ? 10/98 10%
    (4.2% to 16%)
    metabolic ? 8/98 8.2%
    (2.7% to 14%)
    cardiac arrest ? 4/98 4.1%
    (0.2% to 8.0%)
    cerebral tumour ? 4/98 4.1%
    (0.2% to 8.0%)
    infection ? 4/98 4.1%
    (0.2% to 8.0%)
    trauma ? 3/98 3.1%
    (0.0% to 6.5%)

    • 52% (95% CI: 41 to 62) with previous seizure disorder
    • 71% (95% CI: 63 to 80%) recovered without permanent sequelae
    • 14% (95% CI: 7.4 to 21%) died (mainly from the cause of the status episode)

    Comments

    1. No information was given on the length of follow-up.

    Citation

    1. Aminoff MJ, and Simon RP: Status epilepticus: causes, clinical features and consequences in 98 patients. American Journal of Medicine 1980; 69: 657-665
    Search Terms: reference in review article
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient status epilepticus
    Intervention or Exposure prevalence
    Outcome causes