Abstracts

Rationale: A high incidence of epilepsy, and a high percentage of preventable causes of epilepsy in all ages haves been shown in the low resources country of Honduras, Central America. There is widespread non-adherence to anti-epileptic drugs(AED) and use of complementary and alternative medicines reported in Honduras. A recent epidemiologic study of convulsive status epilepticus (CSE) in Honduran children demonstrated a long duration of CSE until onset of treatment. The etiologies, treatment, and outcomes of CSE in Honduran adults have not been thoroughly studied. Methods: Patients were consecutively enrolled from November 2008 to May 2009. Institutional Review Board (IRB) approval of the study was obtained at the Medical University of South Carolina and the National Autonomous University of Honduras (NAUH), in Tegucigalpa, Honduras. Informed consent was signed before study participation. Inclusion and Exclusion Criteria: All patients 18 years and older presenting to the NAUH teaching hospital "Hospital Escuela" adult medical emergency room during the defined study period with a convulsive seizure equal to or greater than 5 minutes were included. Patients who were pregnant, prisoners, or institutionalized when presenting with CSE were excluded. Etiology: CSE etiologies were determined by history, laboratory testing, neuroimaging, and electroencephalogram (EEG). All CSE events were classified according to International League Against Epilepsy guidelines based on semiologic description. Emergency Room and In-patient Treatment: The 1st and 2nd line AED(s) used to treat the CSE were evaluated. Emergency Room and In-patient Outcomes: The primary outcome measure was mortality. Results: Thirty-two patients were enrolled. There were 19 females (59.4%) and 13 males (41.4%). CSE was most common in the 18 to 30 year age range, and percentages trended down as age increased. Diazepam was used as the 1st line AED in 24 cases (75.0%);phenytoin was used in 24 of 31 cases (77.4%) as 2nd line therapy. Etiologic risk factors were present in all patients. A high percentage of patients had a previous history of epilepsy n=25 (78.1%); AED non-adherence was seen in 19 patients (76.0%) with epilepsy; and alcohol abuse was confirmed in 6 (22.2%). Short-term in-patient mortality data revealed 3 (10.7%) deaths. Conclusions: The majority (78.1%) of patients presenting to Hospital Escuela with CSE have a prior history of epilepsy. Etiologies were varied, but non-adherence to AEDs comprised the largest percentage (76.0%) of CSE patients. Diazepam and phenytoin were the most common 1st line and 2nd line AED used. Mortality rate in this pilot CSE study from Honduras was 10.7%. Strategies to improve AED compliance in this population appear to be the most fruitful avenue to pursue to decrease the rate of adult CSE.