Acute symptomatic status epilepticus: Splitting or lumping? A proposal of classification based on real-world data

Area of Science:

• Neurology
• Epileptology
• Clinical Outcome Research

Background:

• Status epilepticus (SE) is a neurological emergency with diverse etiologies.
• Understanding the specific causes of SE is essential for predicting patient prognosis and guiding treatment strategies.
• Previous classifications of SE etiologies may not fully capture the nuances of acute symptomatic causes and their impact on outcomes.

Purpose of the Study:

• To categorize acute symptomatic etiologies of status epilepticus (SE) into distinct subcategories.
• To investigate the association between these etiological subcategories and clinical outcomes in patients with SE.
• To identify specific SE causes that predict a poor prognosis.

Main Methods:

• Retrospective analysis of consecutive SE episodes.
• Categorization of etiologies into broad groups (acute, remote, progressive, defined syndromes, unknown).
• Further subcategorization of acute etiologies into four distinct groups: medication-related, acute-primary CNS insults, acute-secondary CNS insults, and intoxication/withdrawal.

Main Results:

• Poor outcome at discharge (worsening of modified Rankin Scale) was observed in 55.6% of cases.
• Acute-primary CNS insults (OR=3.61), acute-secondary CNS insults (OR=1.80), and progressive SE (OR=2.65) were significantly associated with poor outcomes.
• Factors such as older age, nonconvulsive semiology with coma, and treatment refractoriness/superrefractoriness also increased the odds of a poor outcome.

Conclusions:

• Significant heterogeneity exists within the acute symptomatic causes of SE.
• Specific etiological subcategories, particularly acute-primary and acute-secondary CNS insults and progressive SE, are important predictors of clinical outcome.
• These findings highlight the need for refined etiological classification to better inform prognosis and management of SE.