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

Xiuxiu Leng, Fang Yuan, Jingjing Zhao, Changgeng Song, Zhihan Zhao, Yaoyao Zhang, Qiong Gao, Fang Yang, Wen Jiang
Seizure: the Journal of the British Epilepsy Association 2019, 69: 70-75

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.

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