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Convulsive status epilepticus: clinical profile in a developing country.
Epilepsia. 2007 Dec; 48(12):2217-23.E

Abstract

PURPOSE

In developing countries optimal care of status epilepticus (SE) is associated with major barriers, particularly transportation.

METHODS

A prospective study of SE was performed between 1994 and 1996 to determine the clinical profile, response to treatment and outcome, Glasgow Outcome Scale (GOS).

RESULTS

Of the 85 patients admitted, the mean age was 33 years (8-75 years), 16% <16 years of age. The mean duration of SE before admission was 18.02 h (1-72 h). Only 23 (28%) patients, all locals, presented within <3 h of onset. Etiology included acute symptomatic (54%), remote symptomatic (7%), cryptogenic (19%), and established epilepsy (20%). Central nervous system infections accounted for 24 (28%) of the etiologies. Seventy-five (88%) patients responded to first-line drugs and 10 (12%) required second-line drugs. The mean duration of SE was significantly long in nonresponders (Mean +/- SD: 32.6 +/- 20.11 vs. 15.2 +/- 18.32, p < 0.006). Duration (p < 0.01; OR 1.04, 95% CI 1.01-1.07) and acute symptomatic etiology (p < 0.038; OR 10.38, 95% CI 1.13-95.09) were the independent predictors of no-response to first-line drugs. Of the nine deaths (10.5%), eight were in acute symptomatic group. Predictors of mortality included female sex (p < 0.017, OR 13.41, 95% CI 1.59-115.38) and lack of response to first-line drugs (p < 0.0001, OR 230.27, 95% CI 8.78-6037.19). Longer duration was associated with poor GOS 1-4 (p = 0.001). Of the 37 patients with <6 h, 81% had GOC5 outcome.

CONCLUSION

This study suggests that longer duration of SE and acute symptomatic etiology are independent predictors of lack of response to first-line drugs. Failure to respond to first-line drugs and duration predict the outcome.

Authors+Show Affiliations

Murthy JM
Department of Neurology, The Institute of Neurological Sciences, CARE Hospital, Hyderabad, India. jmkmurthy@satyam.net.in
Jayalaxmi SS
No affiliation info available
Kanikannan MA
No affiliation info available

MeSH

AdolescentAdultAgedAnticonvulsantsChildDeveloping CountriesFemaleGlasgow Outcome ScaleHospitalizationHumansIndiaMaleMiddle AgedOutcome Assessment, Health CareProspective StudiesSex FactorsStatus EpilepticusSurvival AnalysisTime FactorsTreatment Outcome

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17651412

Citation

Murthy, Jagarlapudi M K., et al. "Convulsive Status Epilepticus: Clinical Profile in a Developing Country." Epilepsia, vol. 48, no. 12, 2007, pp. 2217-23.
Murthy JM, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia. 2007;48(12):2217-23.
Murthy, J. M., Jayalaxmi, S. S., & Kanikannan, M. A. (2007). Convulsive status epilepticus: clinical profile in a developing country. Epilepsia, 48(12), 2217-23.
Murthy JM, Jayalaxmi SS, Kanikannan MA. Convulsive Status Epilepticus: Clinical Profile in a Developing Country. Epilepsia. 2007;48(12):2217-23. PubMed PMID: 17651412.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Convulsive status epilepticus: clinical profile in a developing country. AU - Murthy,Jagarlapudi M K, AU - Jayalaxmi,Sita S, AU - Kanikannan,Meena A, Y1 - 2007/07/25/ PY - 2007/7/27/pubmed PY - 2008/1/26/medline PY - 2007/7/27/entrez SP - 2217 EP - 23 JF - Epilepsia JO - Epilepsia VL - 48 IS - 12 N2 - PURPOSE: In developing countries optimal care of status epilepticus (SE) is associated with major barriers, particularly transportation. METHODS: A prospective study of SE was performed between 1994 and 1996 to determine the clinical profile, response to treatment and outcome, Glasgow Outcome Scale (GOS). RESULTS: Of the 85 patients admitted, the mean age was 33 years (8-75 years), 16% <16 years of age. The mean duration of SE before admission was 18.02 h (1-72 h). Only 23 (28%) patients, all locals, presented within <3 h of onset. Etiology included acute symptomatic (54%), remote symptomatic (7%), cryptogenic (19%), and established epilepsy (20%). Central nervous system infections accounted for 24 (28%) of the etiologies. Seventy-five (88%) patients responded to first-line drugs and 10 (12%) required second-line drugs. The mean duration of SE was significantly long in nonresponders (Mean +/- SD: 32.6 +/- 20.11 vs. 15.2 +/- 18.32, p < 0.006). Duration (p < 0.01; OR 1.04, 95% CI 1.01-1.07) and acute symptomatic etiology (p < 0.038; OR 10.38, 95% CI 1.13-95.09) were the independent predictors of no-response to first-line drugs. Of the nine deaths (10.5%), eight were in acute symptomatic group. Predictors of mortality included female sex (p < 0.017, OR 13.41, 95% CI 1.59-115.38) and lack of response to first-line drugs (p < 0.0001, OR 230.27, 95% CI 8.78-6037.19). Longer duration was associated with poor GOS 1-4 (p = 0.001). Of the 37 patients with <6 h, 81% had GOC5 outcome. CONCLUSION: This study suggests that longer duration of SE and acute symptomatic etiology are independent predictors of lack of response to first-line drugs. Failure to respond to first-line drugs and duration predict the outcome. SN - 0013-9580 UR - https://www.unboundmedicine.com/medline/citation/17651412/Convulsive_status_epilepticus:_clinical_profile_in_a_developing_country_ DB - PRIME DP - Unbound Medicine ER -