Status epilepticus in male and female patients: Clinical presentation, management, and outcomes

Sex-specific differences in neurological emergencies such as status epilepticus (SE) remain insufficiently characterized. This study investigated sex-related differences in etiology, diagnostics, treatment, and outcomes of SE.

We conducted a retrospective cohort study of 779 patients treated for SE at Marburg University Hospital between 2011 and 2023. Demographic, clinical, diagnostic, therapeutic, and outcome data were extracted from medical records and compared between sexes.

Female patients were significantly older at SE onset and more frequently presented with non-convulsive or de novo SE, whereas male patients more often had pre-existing epilepsy and were more frequently on antiseizure medication (ASM) and received prehospital benzodiazepines more often. In-hospital treatment was largely guideline-concordant in both sexes, although female patients more frequently received lorazepam. Diagnostic procedures were more often performed in female than in male patients (EEG, MRI). Female patients had poorer functional outcomes at discharge, were less often discharged home, and showed higher one-year mortality in unadjusted analyses. However, these differences were not independently associated with sex after adjustment for confounders.

Sex-specific differences in presentation and diagnostic work-up of SE were observed, while in-hospital treatment was largely comparable between sexes. Although outcome differences were seen in unadjusted analyses, these were not independent after adjustment for key confounders. Overall, these findings suggest that observed disparities are primarily driven by clinical and demographic factors rather than sex itself.