Fatal status epilepticus: a clinico-pathological analysis among 100 patients: from a developing country perspective

We evaluated the neuropathological features associated with fatal SE with emphasis on neuroanatomy and etiology, and attempted to correlate with the clinical observations.

Details of 100 (n=100; M:F=64:36) autopsied cases of status epilepticus were studied retrospectively with emphasis on clinico-pathological characteristics.

Sixty-five percent of patients presented for the first time as SE. Patients with prior history of epilepsy (35%), had discontinued treatment in 71.4% of cases, resulting in SE. Majority of patients with SE had generalized convulsive seizures (75%). The mean GCS score at admission was 4.4. Median delay in initiating the treatment following seizure was 23.5h (mean: 29.5±32.8h). The etiological factors could be identified in two-thirds of cases, neuroinfection (n=34) and stroke (n=16) being the commonest. Frontal lobe was the most commonly involved area (38.6%), in both localized and multilobar pathology. Dual pathology was observed in seven patients. Clinico-pathological concordance was noted in 58%. The discordance observed in 42 patients was either due to low index of suspicion for additional etiologies, inaccurate neuroimaging interpretation or non-availability of extensive diagnostic modalities prior to referring to this centre.

This is one of the largest cohort of fatal SE with pathological correlation in the literature. Clinico-pathological concordance was observed in 58% of patients. Neuroinfection and cerebral stroke were observed in two-thirds of patients as the etiological factor. Prolonged duration of SE, long delay in initiating treatment, poor GCS score at admission, poor drug compliance and symptomatic etiologies were common in this cohort of fatal SE from a developing country, most of which could have been preventable.