Change in Mortality of Generalized Convulsive Status Epilepticus in High-Income Countries Over Time: A Systematic...

Area of Science:

• Neurology
• Critical Care Medicine
• Epidemiology

Background:

• Status epilepticus (SE) is a critical neurological emergency associated with high morbidity and mortality.
• Aggressive management strategies for prolonged seizures and SE have been advocated since the late 1990s.

Purpose of the Study:

• To evaluate trends in convulsive SE mortality over time.
• To assess if mortality has decreased with the implementation of earlier and more aggressive treatment protocols.

Main Methods:

• A systematic review and meta-analysis of 61 studies published between 1990 and 2017.
• Inclusion criteria focused on studies of convulsive SE with adequate participant numbers and excluded single-etiology or single-modality treatment studies.
• Data were pooled using a random-effects model to determine proportional mortality.

Main Results:

• Pooled mortality for adult SE was 15.9%, for all populations 13.0%, for pediatric SE 3.6%, and for refractory SE 17.3%.
• No significant evidence of improved survival over time was found.
• Mortality rates were consistently higher in adults compared to children.

Conclusions:

• Convulsive SE mortality has not demonstrably decreased despite evolving treatment paradigms.
• Etiology of SE appears to be a primary determinant of mortality, more so than treatment timing or definition.
• The findings underscore the need for standardized international guidelines for SE research and management.