Treatment practice and outcome of generalized convulsive status epilepticus (GC-SE) in The Netherlands were studied at the Dr Hans Berger Clinic, Breda and University Hospital, Nijmegen, The Netherlands. SIG, a Dutch documentation center that collects nationwide hospital statistics, showed an average annual GC-SE frequency of 344 in patients aged >15 years, with an annual mortality of 24. Of 346 admissions collected at 12 hospitals and 2 epilepsy centers 236 (68%) had known previous epilepsy. Analysis showed that factors important in outcome were the underlying cause, noncompliance with AED treatment, and systemic infection. Of 38 patients who died, 44% had received insufficient therapy. This percentage was higher (62%) in patients dying as a result of SE itself. Duration of SE >4 hours caused an increase in morbidity and mortality, especially in those where GC-SE itself was responsible rather than some underlying cause. Outcome was related to the occurrence of medical complications: respiratory insufficiency and aspiration, cardiac arrhythmias, hypotension, renal and/or hepatic failure, and rhabdomyolysis were associated with a poor prognosis. Inadequate management led to several complications and a worse outcome. [1]

COMMENT. A poor outcome of convulsive status epilepticus is determined particularly by the underlying cause but also by a duration of SE greater than 4 hours, by the occurrence of one or more medical complications, and by inadequate anticonvulsant therapy. Therapies most frequently employed in the management of convulsive status epilepticus in The Netherlands were clonazepam, diazepam, and phenytoin.

Status Epilepticus and Seizure Recurrence. Shinnar S, Berg AT, and Moshe SL, at the Albert Einstein College of Medicine, Bronx, NY, report a study of the effect of status epilepticus on the long-term outcome of a cohort of 342 children and adolescents prospectively followed for a mean of 72 months from the time of their first idiopathic unprovoked seizure (Dev Med Child Neurol March 1995 (suppl 72);37:116 [abstact]). Status epilepticus was the first seizure in 38 (11%). At follow-up, 127 (37%) had experienced a seizure recurrence, including 42% of those who presented with status and 37% of those who had a briefer first seizure. The occurrence of status epilepticus did not appear to have an adverse effect on outcome in the children in this study.