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Seizure. 2019 Jul;69:70-75. doi: 10.1016/j.seizure.2019.04.005. Epub 2019 Apr 8.

Long-term seizure outcome in patients with status epilepticus due to acute encephalitis.

Author information

1
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: lengxx_fmmu@163.com.
2
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: yuanfang@fmmu.edu.cn.
3
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: zhaojing0110@126.com.
4
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: songchanggeng_fmmu@163.com.
5
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: zhihanzhao_44@163.com.
6
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: zhangyaoyao_fmmu@163.com.
7
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: gaoqiong@fmmu.edu.cn.
8
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: fyangx@fmmu.edu.cn.
9
Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China. Electronic address: jiangwen@fmmu.edu.cn.

Abstract

PURPOSE:

To investigate the long-term seizure outcome in patients with convulsive status epilepticus (CSE) due to acute encephalitis and identify early predictors for terminal seizure remission.

METHODS:

Based on a prospective registry of CSE, consecutive patients with CSE due to acute encephalitis were enrolled from July 2009 to November 2017, with follow-up ending in November 2018. Variables during hospital stay, seizure outcomes within 1 month after status epilepticus (SE), and seizure outcomes within 3 months after acute phase of encephalitis were assessed for predicting terminal seizure freedom.

RESULTS:

After a median 58-month observation period, 77 patients were included in this study. Twenty-eight (36%) patients died within 3 months, 22 (29%) patients had recurrent seizures after acute phase of encephalitis, and 27 (35%) patients attained terminal seizure freedom after acute phase of encephalitis. Patients with CSE due to autoimmune encephalitis had a higher rate of terminal seizure freedom than those with viral and other encephalitis. Among all living patients (n = 49), 26 (53%) patients were on anti-epileptic medication at the end of follow-up. STESS score on admission, seizure freedom throughout 1 month after SE, and seizure freedom throughout 3 months after acute phase were found to be independently associated with terminal seizure freedom.

CONCLUSIONS:

Our study proposed a dynamic assessment system to identify patients for whom long-term use of anti-epileptic drugs (AEDs) might not be necessary. Our findings filled a gap in treatment decision on how long AEDs should be continued for patients with CSE due to acute encephalitis.

KEYWORDS:

Anti-epileptic drugs; Convulsive status epilepticus; Prediction; Recurrent seizures; Terminal seizure freedom

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