Status epilepticus in the Netherlands. A study on causes, therapy and outcome.
[S.l.] : [S.n.]
Number of pages
RU Radboud Universiteit Nijmegen, 28 september 2005
Promotor : Renier, W.O.
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SubjectUMCN 3.2: Cognitive neurosciences
This retrospective file study investigated the results of various types of status epilepticus (SE) in the Netherlands. We evaluated 576 adult patients and 112 children. The diagnosis of SE appeared wrong in about 20% of the cases. In both adults (346) and children (82) with generalized convulsive status epilepticus (GCSE) the results were especially determined by the underlying cause, but also by duration of SE, the presence of more than 1 medical complication and the quality of treatment. It can be estimated that in the Netherlands every year 24 adult patients will die and 10 patients will develop morbidity, caused by inadequate therapy of GCSE. Treatment according to protocol may prevent this. In 65 adult patients with non-convulsive status epilepticus the results were also especially determined by the underlying cause; inadequate treatment contributed to morbidity in three patients with complex partial status epilepticus (CPSE). In one adult patient with CPSE the longlasting discharges themselves caused morbidity (memory deficit). Stroke appeared the main cause of simple partial status epilepticus (SPSE) in 47 adult patients, with corresponding poor outcome. It was striking that in 20% of the patients with previous epilepsy a new acute neurological cause of SPSE could be found. In one patient morbidity appeared to be caused by the epileptic discharges themselves. In children we also studied the results of continuous epileptic discharges during sleep in two syndromes, characterized by severe cognitive decline and behaviour disturbances. The syndromes are known as Continuous Spikes and Waves during Sleep (CSWS) and Landau-Kleffner Syndrome (LKS). The results in the ten children we studied were poor, mainly determined by the long duration of the continuous nocturnal epileptic discharges. We stressed the importance of early EEG investigation during sleep in any child with unexplained cognitive decline and/or behaviour disturbances. Early diagnosis is essential to improve prognosis. This study is unique in the Netherlands. In comparison to foreign studies it also provided new information about the relation between outcome on the one hand and medical complications, duration of SE, the presence of previous epilepsy or not and the quality of treatment on the other hand. Our results stress the importance of treatment of status epilepticus according to protocol
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