Predictors of poor outcomes in status epilepticus: insights from a university hospital in Saudi Arabia

B. Aljafen, S. Alwakeel, L. Alwakeel, J. Alghtani, Z. Alkaff, W. Philip

Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. bandaraljafen@gmail.com

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• Neurology

OBJECTIVE: Status epilepticus (SE) is a life-threatening neurological emergency. However, studies on the prognostic factors of adult patients with SE in the Middle East remain lacking. Therefore, the present study aimed to analyze the clinical presentation, causes, and complications of SE and determine predictors of poor outcomes in patients treated in a tertiary care university hospital in Saudi Arabia.

MATERIALS AND METHODS: This retrospective cohort study was conducted in the Department of Medicine, Neurology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia. This study recruited 38 patients aged 14 years or older who met the diagnostic criteria for SE. The median age was 30, and males accounted for 60.5% of cases. The outcomes were assessed using the Glasgow Outcome Scale (GOS).

RESULTS: A history of epilepsy was present among 78.9% of patients; generalized seizures were observed in 89.5%, and focal seizures were observed in 10.59%. The primary complications included respiratory problems (36.89%) and acute kidney injury (23.7%). Antiepileptic drug reduction or withdrawal was the most common etiology in patients with preexisting epilepsy. Systemic infection (42.1%) was the most common cause in the general population, followed by withdrawal or reduction of anti-epileptic drugs (39.5%) and cerebrovascular disease (23.7%). Overall, 36.8% of patients experienced poor outcomes.

CONCLUSIONS: It was concluded that, overall, one-third of patients experienced poor outcomes. The mortality rate was 18.4%. The refractory SE, caused by cerebrovascular disease and respiratory/renal complications, was identified as a significant predictor of poor outcomes. This study highlights poor medication adherence and systemic infections as the primary causes of SE in Saudi Arabia. Refractory SE, respiratory complications, acute kidney injury, and SE due to cerebrovascular disease emerged as key predictors of poor outcomes, emphasizing the importance of addressing the underlying causes and the early recognition and management of complications.

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