Sex-based analysis of status epilepticus management and outcome: A cohort study

Status epilepticus (SE) is a neurological emergency with significant morbidity and mortality. The role of sex as a factor influencing the characteristics, treatment, and outcomes of SE has been scarcely addressed. This study investigates this variable regarding the clinical management and outcome among adult patients with SE. We retrospectively analyzed the Centre Hospitalier Universitaire Vaudois (CHUV) Status Epilepticus Registry (SERCH) over a 10-year period, including 961 SE episodes in 831 patients (56.82% male; 43.18% female), excluding post-axonic cases. There were no statistically significant differences in age, potentially fatal etiology, or pre-treatment consciousness impairment between sexes. Male patients were slightly younger (mean age 61 vs 64 years, p =.03), had a higher prevalence of prior seizures (54.76% vs 47.9%, p = .04), and were more likely to present with generalized convulsive SE (51.5% vs 41%), whereas female patients exhibited a higher frequency of focal unaware SE (31.7% vs 22.1%, global p = .02). Treatment strategies were similar across sexes, with benzodiazepines as first-line therapy in over 80% of cases, levetiracetam being the most frequently prescribed second-line treatment, followed by valproate and lacosamide. Development of refractory SE was comparable between sexes (54% in both, p = .92); outcomes at discharge were also similar. SE refractoriness and return to baseline conditions remained similar after multivariable adjustment for potential confounders. Overall, our results suggest comparable SE management, treatment responsiveness and outcomes between men and women.