CC BY-NC-ND 4.0 · International Journal of Epilepsy 2014; 01(02): 069-074
DOI: 10.1016/j.ijep.2014.11.001
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Status epilepticus in adults: A study from Nigeria

Lukman Femi Owolabi
a   Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
,
Aliyu Ibrahim
a   Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
,
Alhassan Datti Mohammed
b   Department of Anesthesiology and Intensive Care, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
,
Shakirah D. Owolabi
c   Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano PMB 3452, Nigeria
› Author Affiliations
Further Information

Publication History

Received: 24 May 2014

Accepted: 04 November 2014

Publication Date:
04 May 2018 (online)

Abstract

Background Status epilepticus (SE) is a common neurologic emergency. Immediate treatment to stop seizure activity and prompt diagnostic evaluation to recognize potentially treatable causes are paramount in the management of SE. Thus, increased awareness of presentation, etiologies, and treatment of status epilepticus SE is central in the practice of critical care medicine. However, there is a paucity of information on SE from Nigeria.

Objective We evaluated the clinical profile and predictors of one-month outcome in a group of Nigerian patients with SE.

Methodology Patients with SE were recruited from the medical, high dependency unit, intensive care unit and accident and emergency departments of a tertiary hospital from 2008 to 2013. The outcome was assessed using Glasgow Outcome Score (GOS). The outcome, which was categorized into dead (GOS = 1) or alive was analyzed in a multivariate logistic regression model.

Result A total of 76 patients was studied. The four most common underlying etiologies were stroke, antiepileptic drug (AED) non-compliance, CNS infections and metabolic derangement. Fifty-nine (77.6%) patients survived. Duration of seizure, delay in initiation of treatment (Odd ratio (OR) = 4.4, 95% CI = 1.17–16.56), refractory status epilepticus (OR = 87.1, 95% CI = 12.94–781.1) were significantly associated with death. On multivariate analysis, however, refractory status epilepticus remained an independent predictor of death.

Conclusion Our study showed that the most common underlying etiologies in SE were stroke, antiepileptic drug non-compliance CNS infections and metabolic derangement. Duration of seizure, delay in treatment and refractory the SE were significantly associated with death, but refractory seizure was an independent predictor of death in SE.

 
  • References

  • 1 Lowenstein DH. Status epilepticus: an overview of the clinical problem. Epilepsia 40 1999; 3-8
  • 2 Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology 43 1993; 483-488
  • 3 Owolabi LF, Shehu MY, Shehu MN, Fadare J. Pattern of neurological admissions in the tropics: experience in Kano, northwestern Nigeria. Ann Indian Acad Neurol 13 2010; 167-170
  • 4 Ogunniyi A, Ogunniyi JO, Bademosi O, Osuntokun BO, Adeuja AO. Etiology of status epilepticus in Ibadan: a neuropathologic study. West Afr J Med 11 1992; 263-267
  • 5 Aminoff MJ, Simon RP. Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med 69 1980; 657-666
  • 6 Hauser WA. Status epilepticus: frequency, etiology, and neurological sequelae. Delgado-Escueta AV, Wasterlain CG, Treiman DM, Porter RJ. Advances in Neurology. vol. 34 1983. Raven Press; New York: 3-14 Status Epilepticus
  • 7 Cranford RE, Leppik IE, Patrick B, Anderson CB, Kostick B. Intravenous phenytoin in acute treatment of seizures. Neurology 29 1979; 1474-1479
  • 8 Claassen J, Lokin JK, Fitzsimmons BFM, Mandelssohn FA, Mayer SA. Predictors of functional disability and mortality after status epilepticus. Neurology 58 2002; 139-142
  • 9 Sagduyu A, Tarlacci S, Sirin H. Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality. J Neurol 245 1998; 640-646
  • 10 Commission on Classification and Terminology of the International League Against Epilepsy. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 22 1981; 489-501
  • 11 Hui ACF, Joynt GM, Li H, Wong KS. Status epilepticus in Hong Kong Chinese: etiology, outcome and predictors of death and morbidity. Seizure 12 2003; 478-482
  • 12 Committee on Protocol for the Management of Medical Emergencies in Aminu Kano Teaching Hospital. Protocol for the Management of Status Epilepticus. vol. 1 2009. Endem Press; 102-105
  • 13 Brainin M, Barnes M, Baron JC. et al. Guidance for the preparation of neurological management guidelines by EFNS scientific task forces – revised recommendations 2004. Eur J Neurol 11 2004; 577-581
  • 14 Claassen J, Hirsch LJ, Mayer SA. Treatment of status epilepticus: a survey of neurologists. J Neurol Sci 211 2003; 37-41
  • 15 Murthy JMK, Jayalaxmi SS, Kanikannan MA. Convulsive status epilepticus: clinical profile in a developing country. Epilepsia 48 2007; 2217-2223
  • 16 Jennett B, Bond M. Assessment of outcome after severe brain damage. A practical scale. Lancet 1 1975; 480-484
  • 17 Mhodj I, Nadiaye M, Sene F. et al. Treatment of status epilepticus in a developing country. Neurophysiol Clin 30 2000; 165-169
  • 18 Towne AR, Pellock JM, Ko D, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 35 1994; 27-34
  • 19 Ozdilek B, Midi I, Agan K, Bingol CA. Episodes of status epilepticus in young adults: etiologic factors, subtypes, and outcomes. Epilepsy Behav 27 2013; 351-354
  • 20 Tatum WO, French JA, Benbadis SR, Kaplan PW. The etiology and diagnosis of status epilepticus. Epilepsy Behav 2 2001; 311-317
  • 21 Treiman DM, DeGiorgio CM, Salisbury SM, Wickboldt CL. Subtle generalized convulsive status epilepticus. Epilepsia 25 1984; 653
  • 22 Kaplan PW. Nonconvulsive status epilepticus. Sem Neurol 16 1996; 33-40
  • 23 Treiman DM. Effective treatment for status epilepticus. Schmidt D, Schachter SC. Epilepsy Problem Solving in Clinical Practice. 2000. Martin Dunitz Ltd; United Kingdom: 253-265
  • 24 Li JM, Chen L, Zhou B, Zhu Y, Zhou D. Convulsive status epilepticus in adults and adolescents of southwest China: mortality, etiology, and predictors of death. Epilepsy Behav 14 2009; 146-149
  • 25 Celesia GC, Messert B, Murphy J. Status epilepticus of late adult onset. Neurology 22 1972; 1045-1055
  • 26 Owolabi LF, Nagoda M. Stroke in developing countries: experience at Kano, Northwestern Nigeria. Sudan JMS 7 2012; 9-14
  • 27 Massaro AR. Stroke in Brazil: a South America perspective. Int J Stroke 1 2006; 113-115
  • 28 Owolabi LF, Akinyemi RO, Owolabi MO, Sani MU, Ogunniyi A. Profile of stroke-related late onset epilepsy among Nigerians. J Med Trop 15 2013; 29-32
  • 29 Jones JE, Hermann BP, Barry JJ, Gilliam FG, Kanner AM, Meador KJ. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy Behav 4 2003; S31-S38
  • 30 Faught E, Duh MS, Weiner JR, Gu'erin A, Cunnington MC. Non-adherence to anti-epileptic drugs and increased mortality: findings from the RANSOM study. Neurology 70 2008; 1572-1578
  • 31 DeLorenzo RJ, Hauser WA, Towne AR. et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 46 1996; 1029-1035
  • 32 Owolabi LF. Precipitants of seizure among patients with epilepsy: experience at Kano, Northwestern Nigeria. Sahel Med J 15 2012; 24-29
  • 33 Garzon E, Fernandes RM, Sakamoto AC. Analysis of clinical characteristic and risk factors for mortality in human status epilepticus. Seizure 12 2003; 237-245
  • 34 Maharaj M, Henry D, Alik K, Mohammed PD. Status epilepticus: recent experience at the Port-of-Spain General Hospital, Trinidad. West Indian Med J 41 1992; 19-22
  • 35 Kwong KL, Lee SL, Yung A, Wong VC. Status epilepticus in 37 Chinese children: etiology and outcome. J Paediatr Child Health 31 1995; 395-398
  • 36 Koubeissi M, Alshekhlee A. In-hospital mortality of generalized convulsive status epilepticus: a large US sample. Neurology 69 2007; 886-893
  • 37 Legriel S, Mourvillier B, Bele N. et al. Outcomes in 140 critically ill patients with status epilepticus. Intensive Care Med 34 2008; 476-480
  • 38 Hesdorfer DC, Logroscino G, Cascino G, Annegars JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1986. Neurology 50 1998; 735-741
  • 39 Waterhouse EJ, Garnett LK, Towne AR. et al. Prospective population-based study of intermittent and continuous convulsive status epilepticus in Richmond, Virginia. Epilepsia 40 1999; 752-758
  • 40 Coeytaux A, Jallon P, Galobardes B. et al. Incidence of status epilepticus in French speaking Switzerland (EPISTAR). Neurology 50 1998; 735-741
  • 41 Owolabi LF, Mohammed AD, Dalhat MM, Ibrahim A, Aliyu S, Owolabi DS. Factors associated with death and predictors of 1-month mortality in nontraumatic coma in a tertiary hospital in Northwestern Nigeria. Indian J Crit Care Med 17 2013; 219-223