Abstracts

RATIONALE: We reviewed clinical records of 1520 adults outpatients (800 females, 720 males; mean age: 40.6 years) in order to evaluate the prevalence of status epilepticus (SE) in a group of patients referring to a medical center for epilepsy.
METHODS: On the basis of clinical and EEG data, we divided SE into generalized convulsive (tonic-clonic, and myoclonic), generalized nonconvulsive, and partial (convulsive and nonconvulsive).
RESULTS: Eighty patients (5.3%) had one or more SE, with higher prevalence in males (44 pts.: 6.1%) than in females (36 pts.: 4.5%). The mean age at the appearance of the (first) SE was 28.8 years (range: 1 month to 67 years). Thirty-eight pts. (47.5%) have a generalized epilepsy (idiopathic [IGE] in 18, cryptogenetic or symptomatic [C/SGE] in 20), 42 pts. (52.5%) have a partial epilepsy (cryptogenetic [CPE] in 11, symptomatic [SPE] in 31). The prevalence of SE was 5.3% in IGE (18 of 340 pts.), 15.3% in C/SGE (20 of 131 pts.), 2.2% in CPE (11 of 500 pts.), 6.2% in SPE (31 of 500 pts.). None of 49 pts. with idiopathic partial epilepsy had SE. SE was generalized convulsive in 38 pts. (47.5%; 7 with IGE, 12 with C/SGE, 19 with partial epilepsy), generalized nonconvulsive in 14 pts. (17.5%; 10 with IGE, 4 with C/SGE), myoclonic in 6 pts. (7.5%; 1 with IGE, 4 with C/SGE, 1 with partial epilepsy), partial convulsive in 5 pts. (6.2%), partial nonconvulsive in 17 pts. (21.3%). A precipitating factor of SE is recognizable in 39 pts. (49%), often pharmacological (36 pts.; fever in the 3 other): suspension or reduction in AED therapy in 17 pts. (36.8% of generalized convulsive SE, 7.1% of other SE; by patient itself in 14 cases, iatrogenic in 3); administration of a new AED in 18 pts. (64.3% of generalized nonconvulsive SE, 83.3% of myoclonic SE, 17.6% of partial nonconvulsive SE); estrogen at high doses in 1 pt. with generalized nonconvulsive SE. In detail: a) 9 pts. had a generalized nonconvulsive SE after administration of CBZ, PHT, VGB or TGB; b) LTG caused a myoclonic SE in 4 pts. (3 pts. with severe myoclonic epilepsy and 1 pt. suffering from epilepsy with myoclonic absences); c) 3 pts. had a partial nonconvulsive SE after add-on of TGB. Nineteen pts. (1.25% of total group) experienced a SE as first sign of the epileptic syndrome; 15 of these have a symptomatic partial epilepsy. Other 19 pts. had multiple SE; 6 of these at least 10 episodes (2 pts. with Lennox-Gastaut syndrome, 3 female pts. suffering from IGE with absences).
CONCLUSIONS: Our data show that about 5% of patients suffering from chronic epilepsy experienced at least an episode of SE, and that pharmacological factors are relevant in 45% of these patients.
[Supported by: University of Turin.]