Etiological features of status epilepticus of the in-patient cohort in Tibet: A retrospective comparative study

The etiology of status epilepticus (SE) in Tibet has not yet been reported. We aimed to establish the etiological baseline of SE in the Tibet Autonomous Region in China and compare it with a SE cohort from a regional neuroscience centre in Sichuan, Southwestern China to reveal whether there was a unique etiology distribution in the Tibetan region.

We retrospectively captured clinical data of patients diagnosed with SE in the People's Hospital of Xizang Autonomous Region from January 2015 to December 2020. Control data were recorded during the same period from West China Hospital of Sichuan University, Sichuan Province. Clinical and etiology evaluations were conducted by 4 neurologists using a standard case report form.

A total of 619 patients were enrolled, among whom 318 were from the Tibetan cohort. The median age of the Tibetan cohort was 37.5 years, with 109 (34.3%) being women. The main etiology in the Tibetan cohort was uncontrolled persistent epilepsy (70.1%, N = 223). Compared to the control cohort, the proportion of patients in Tibet whose SE could be controlled was higher (97.5% vs 81.1%, p<.001) and the proportion of patients with refractory SE was lower (8.8% vs 35.2%, p<.001). Among the 223 patients with epilepsy who developed SE, 111 had never been treated with anti-seizure medication, and 52 (23.3%) were judged only to have received inappropriate treatment of epilepsy. Forty patients (17.9%) were only receiving treatment with traditional Tibetan medicine for epilepsy prior to admission. Patients with epilepsy of infectious etiology were seen in 37 patients in Tibetan cohort. In twenty-eight patients neurocysticercosis was identified as the cause of epilepsy. And in two patients, the cause of epilepsy was brain hydatid.

The main etiology of SE in the Tibet Autonomous Region was unsatisfactory seizure control in patients with pre-existing epilepsy, while a greater proportion of epilepsy due to infectious causes was noted. Improved education for physicians and patients is needed to improve the management of epilepsy and SE in this population.