Status epilepticus (SE) is a neurological emergency characterized by a prolonged seizure lasting more than 30 minutes, or a person having multiple seizures with no recovery between them. Many standard therapies are available for this disorder, but they are only effective if SE patients are treated as soon as possible after being diagnosed. The occurrence of more severe adverse events may aggravate the condition and raises the mortality rate. This literature review is focused on reporting the adverse outcome of SE and standard treatment approaches.
For this literature review, we have identified 78 articles via comprehensive searching using the PubMed database, of which 74 were selected. Neurological dysfunction was reported as the most common outcome among SE patients. The high mortality rate was mainly due to co-morbidities associated with the disorder. Other adverse outcomes reported in SE patients were respiratory failure, hypotension, septic shock, renal failure, and rhabdomyolysis. Convulsive SE (CSE) is a life-threatening condition mostly present in pediatric that is characterized by prolonged tonic- clonic seizures and always requires a medical emergency. In terms of seizures, elders are more prone than the younger ones. The refractory status epilepticus (RSE) and super-refractory SE (SRSE) conditions increase hospitalization and the risk of mortality.
Adverse outcomes are initially managed by checking airway status, blood pressure, cardiac rhythm, circulatory support, and obtaining intravenous (IV) access in large veins. SE can reoccurred in patients even after receiving the proper treatment. So, to do this, it is necessary to develop an effective treatment strategy for preventing the reoccurrence. Clinicians should strengthen their research and development strategies for the development of effective novel molecules for the prevention of the reoccurrence of SE.
In conclusion, SE conditions can cause severe and serious adverse outcomes, which could lead to a high mortality rate. This review article highlights the need for regular follow-up of patients. Moreover, further research and randomized controlled studies are required to develop an effective treatment for SE.
Status epilepticus (SE) is a life-threatening neurological disorder in which seizures activity last for more than 30 minutes or a person may experience more seizures without recovery between them. 1, 2, 3, 4 The SE is mainly caused by brain trauma, infections, cerebrovascular disorders, epilepsy syndromes, and low concentrations of the antiepileptic drug in epilepsy patients.4
The symptoms of the SE depend upon its types, ie, convulsive SE and non-convulsive SE. In convulsive SE, patients mostly experience limb stiffness, jerking motions, drooling, rapid eye movements, and grunting sounds, while in non-convulsive SE, patients usually experience amnesia, confusion, clouding of consciousness, unusual behaviors, daydreaming, and speaking problem. 5, 6, 7, 8
The prevalence of SE increases simultaneously across all the age groups from previous years and is expected to rise in the coming years. The yearly incidence of SE is up to 61 per 100,000 in adults and up to 20 per 100,000 in children.
The mortality rate varies between 3-50% and is approximately 3%, in children, while the adult has a high mortality rate, ie, up to 50%. 9,10, 1,11 The incidence rates have increased over time and are estimated to range from 4 to 41 per 100,000 per year in the United States. The incidence rate of SE is higher in developing countries than the developed countries. 12, 13, 14
Around 30% of SE patients show resistance against the primary treatment and, 15 some patients delay the treatment after diagnosis, which increases the chance for the development of adverse outcomes such as metabolic disorder, thrombotic thrombocytopenic purpura, eclamptic seizures, multi-organ dysfunctions, cardiac issues, respiratory and permanent neurological damage.1,9
Moreover, the adverse outcomes associated with SE disorder can lead to morbidity and mortality. Therefore, this literature review summarizes the adverse outcomes of SE and known treatment strategies.
This literature review was performed to describe the adverse outcomes of SE and treatment strategies based on already published articles. We identified 78 articles via comprehensive searching using the PubMed database and selected 74 relevant published articles for this review. To create a search strategy, the following terms were used: “status epilepticus ORSE”, “causes AND status epilepticus”, “epidemiology AND status epilepticus”, prevalence AND status epilepticus”, “status epilepticus AND mortality”, “status epilepticus complication”, “adverse outcome of status epilepticus”, “guidelines for prevention AND status epilepticus”, “current treatment for status epilepticus”, “future treatment against status epilepticus”, “development of a drug for status epilepticus”, and “new treatment for status epilepticus”. The search was not limited by period. All the prospective or retrospective studies and reviews were included where the main focus was epidemiology, prevalence, mortality, adverse outcomes, and the treatment options or strategies. The important data from selected studies were extracted into a separate bibliographic report.
Adverse outcomes of status epilepticus
SE has become a major public health concern due to the significant morbidity and mortality rates and associated adverse outcomes such as cognitive impairment, permanent neurological deficits, and subsequent epilepsy. Various risk factor significantly affect the outcomes of SE or sometimes increases the mortality rate in the SE patients. The adverse outcomes are discussed below Figure 2 and presented in Table 1 and Table 2.
Neurological deficit is a very frequent adverse outcome reported in children because seizures directly affect the brain system when they persists for a long time. 16 Cerebral edema occurs when water starts accumulating in the intra or extracellular spaces of the brain which stops the oxygen circulation in the brain and results in brain damage. 17, 18, 19 Therefore cerebral edema increases the fatality in SE patients. 20, 21 This was reported in 5 SE children. Four children were reported to have brainstem dysfunction and cytotoxic edema with cerebral herniation, while 1 child had laminar necrosis. All children died due to severe brain swelling. 22
Seizures activity for more than 30 minutes was the first sign of SE condition, which leads to neurological problems or sometimes damages the neurological system if seizures did not end immediately. The commonly reported neurological problems (>2%) were epilepsy (4.1%), speech impairment (2.8%), and motor impairment (2.8%; Figure 3).23
Including neurological deficit, the risk of neurological deterioration is also high in the SE children who have a history of CNS disorder or progressive encephalopathy. This was observed in the retrospective study conducted on 25 SE patients in a regiona
Including neurological deficit, the risk of neurological deterioration is also high in the SE children who have a history of CNS disorder or progressive encephalopathy. This was observed in the retrospective study conducted on 25 SE patients in a regional hospital in Hong Kong. Of 25 SE
patients, 15 (60%) had a history of neurological abnormality and 11 (44%) seizure disorders. Neurological deteriorations were observed in 6 children. These included mental retardation or paresis, behavioural problems, learning problems, and memory skills. The duration of SE was more frequent and long in patients who developed adverse outcomes. Adverse outcome associated with acute or remote aetiology and refractory SE (P<0.05). Two patients reported fatalities: one died of wolf syndrome and multiorgan failure, while the second one died of encephalitis. 24
If seizure activity does not stop within 10 minutes, then it can lead to brain damage and death. A retrospective study aimed to assess the immediate outcome, clinical profile, and risk factors in the SE patients in the tertiary care center, India. Of 30 patients, 9 (30%) died due to >45 minutes seizure activity (p-0.001) and septic shock (p-0.001). The most common (>25%) adverse outcomes reported were generalized tonic-clonic seizure (63%) and partial seizure (27%). 25 Therefore, there is a need to stop the seizure activity as soon as possible to improve the SE outcome. In a case study, a 27-year-old woman with SE reported episodes of left facial twitching, decreased sensation to pinprick, neuronal loss, focal perivascular, and intraparenchymal lymphocytic infiltrates. A week later, she died while sleeping at home. 26
Risk factors significantly affect the outcomes of SE or sometimes increase the mortality rate in the SE patients. A study was conducted to identify the risk factors determining the outcomes in 92 SE children aged 1 month to 12 years. Of 92 patients, 87 cases were analyzed of which 74 (85%) have recovered, 5 (5%) developed neurological sequele, and 13 (15%) died mainly due to IE metabolism (50%), acute CNS infection (24%), remote causes (24%), and non-compliances (20%). The risk factors that significantly (p <0.05) affected the SE outcome were decompensated shock, hypoxia, acidosis, and respiratory failure. 13, 27, 28, 29, 30 Few other studies also reported risk factors associated with the poor functional outcome of SE such as acute symptomatic etiology (p <0.001), older age
(P = 0.036), seizure (P = 0.043), burst suppression (P = 0.016), and periodic discharge during initial EEG (P < 0.0001). 31, 32
Convulsive SE (CSE) is a life-threatening condition mostly present in pediatric, which is characterized by prolonged tonic-clonic seizures and always required a medical emergency. This was reported by a cohort study conducted on 70 SE children in the children hospital of Cairo University, Egypt. Twenty-six (37%) patients reported mortality, and 15 (21%) have a severe disability due to refractory CSE. Therefore, the refractory CSE was considered as a significant predictor of morbidity and mortality in the SE patients. 33 Another study reported recurred seizure (16%), mental retardation (16%), and mental retardation along with seizure (16%) in the CSE kids. The mortality rate was 6% due to acute symptomatic (11%), febrile (2%), progressive encephalopathy (7%), and idiopathic (1%). 31 It was also reported that acute bacterial meningitis can be a possible predictor of the first episode of CSE in children. 34 Neuropsychological impairments in the infants started early within 6 weeks and were present later for 1 year post CSE.35
In non-convulsive SE (NCSE), patients have an absence of prolonged seizures. De novo SE patients are more likely to develop NCSE and have poorer outcomes. This was observed in the retrospective study, which aimed to assess the adverse outcomes of de novo 87 SE patients admitted to intensive care units of two hospitals in Hong Kong. Mortality was reported in 18% of patients and 46% of patients reported poor outcomes on discharge. The most commonly reported outcomes (>11%) with various etiologies were breakthrough seizure (21%), encephalitis/meningitis (18%), and cerebrovascular accident (12%). 36 In a case study, a 46-year- old male developed new-onset refractory status epilepticus (NORSE) due to primary angiitis of the central nervous system (PACNS) which is a very rare form of vasculitis (inflammation of blood
vessels). The early diagnosis of PACNS and treatment with immunotherapy can improve the outcome of NORSE. The patient also reported neurophysiology outcomes such as a state of confusion and frequent non-convulsive seizures. Cerebrospinal fluid (CSF) analysis is useful in the diagnosis of PACNS and the findings showed an increased level of protein. 37
The incidence of SE or prolonged seizures is more in older than younger populations, which carry a high risk of mortality and morbidity. This was observed in the study, which aimed to assess the outcome of SE in 121 patients and risk factors including age, pre-existing epilepsy, and co- morbidities during the follow-up. The mortality rate was statistically significant among an older population (53.7%; p <0.0001) mainly due to co-morbidities such as stroke, tumor, and infection. Focal, generalized & combined types of epilepsy were reported in 67 (50%), 47 (35%), and 21
(16%) patients, respectively, and 9 (7%) patients had NCSE. 27
In refractory status epilepticus (RSE) condition, seizures do not respond to treatment therapy and persist for longer than 60 minutes. 1, 38 The RSE condition increases hospitalization and mortality rates. A retrospective cohort study conducted in New York, United States, aimed to assess the incidence, risk factors, and effect on the outcome of RSE in 74 SE patients. Of 74 SE patients, 26 (35.1%) were RSE, and 57 (77.0%) were non-RSE. Seizure duration, length of hospital stay, and the mortality rate was higher in the RSE than non-RSE patients (20.1 hours vs 2.5 hours; p<0.001, 32.5 days vs. 1.0 days; p<0.001, and 23% vs. 14%; p = 0.31, respectively). The most commonly reported complications (> 50%) in RSE patients were respiratory failure (88%; p = 0.02), fever (81%; p = 0.004), pneumonia (65%; p = 0.004), and hypotension (65%; p < 0.001; Figure 5: Treatment Option for Status Epilepticus Patients) and non-RSE patients reported were respiratory failure (63%; p = 0.02) and tachycardia (86%; p = 0.56). 39
l hospital in Hong Kong. Of 25 SE patients, 15 (60%) had a history of neurological abnormality and 11 (44%) seizure disorders. Neurological deteriorations were observed in 6 children. These included mental retardation or paresis, behavioural problems, learning problems, and memory skills. The duration of SE was more frequent and long in patients who developed adverse outcomes. Adverse outcome associated with acute or remote aetiology and refractory SE (P<0.05). Two patients reported fatalities: one died of wolf syndrome and multiorgan failure, while the second one died of encephalitis. 24
If seizure activity does not stop within 10 minutes, then it can lead to brain damage and death. A retrospective study aimed to assess the immediate outcome, clinical profile, and risk factors in the SE patients in the tertiary care center, India. Of 30 patients, 9 (30%) died due to >45 minutes seizure activity (p-0.001) and septic shock (p-0.001). The most common (>25%) adverse outcomes reported were generalized tonic-clonic seizure (63%) and partial seizure (27%). 25 Therefore, there is a need to stop the seizure activity as soon as possible to improve the SE outcome. In a case study, a 27-year-old woman with SE reported episodes of left facial twitching, decreased sensation to pinprick, neuronal loss, focal perivascular, and intraparenchymal lymphocytic infiltrates. A week later, she died while sleeping at home. 26
Risk factors significantly affect the outcomes of SE or sometimes increase the mortality rate in the SE patients. A study was conducted to identify the risk factors determining the outcomes in 92 SE children aged 1 month to 12 years. Of 92 patients, 87 cases were analyzed of which 74 (85%) have recovered, 5 (5%) developed neurological sequele, and 13 (15%) died mainly due to IE metabolism (50%), acute CNS infection (24%), remote causes (24%), and non-compliances (20%). The risk factors that significantly (p <0.05) affected the SE outcome were decompensated shock, hypoxia, acidosis, and respiratory failure. 13, 27, 28, 29, 30 Few other studies also reported risk factors associated with the poor functional outcome of SE such as acute symptomatic etiology (p <0.001), older age (P = 0.036), seizure (P = 0.043), burst suppression (P = 0.016), and periodic discharge during initial EEG (P < 0.0001). 31, 32
Convulsive SE (CSE) is a life-threatening condition mostly present in pediatric, which is characterized by prolonged tonic-clonic seizures and always required a medical emergency. This was reported by a cohort study conducted on 70 SE children in the children hospital of Cairo University, Egypt. Twenty-six (37%) patients reported mortality, and 15 (21%) have a severe disability due to refractory CSE. Therefore, the refractory CSE was considered as a significant predictor of morbidity and mortality in the SE patients. 33 Another study reported recurred seizure (16%), mental retardation (16%), and mental retardation along with seizure (16%) in the CSE kids. The mortality rate was 6% due to acute symptomatic (11%), febrile (2%), progressive encephalopathy (7%), and idiopathic (1%). 31 It was also reported that acute bacterial meningitis can be a possible predictor of the first episode of CSE in children. 34 Neuropsychological impairments in the infants started early within 6 weeks and were present later for 1 year post CSE. 35
In non-convulsive SE (NCSE), patients have an absence of prolonged seizures. De novo SE patients are more likely to develop NCSE and have poorer outcomes. This was observed in the retrospective study, which aimed to assess the adverse outcomes of de novo 87 SE patients admitted to intensive care units of two hospitals in Hong Kong. Mortality was reported in 18% of patients and 46% of patients reported poor outcomes on discharge. The most commonly reported outcomes (>11%) with various etiologies were breakthrough seizure (21%), encephalitis/meningitis (18%), and cerebrovascular accident (12%). 36 In a case study, a 46-yearold male developed new-onset refractory status epilepticus (NORSE) due to primary angiitis of the central nervous system (PACNS) which is a very rare form of vasculitis (inflammation of blood vessels). The early diagnosis of PACNS and treatment with immunotherapy can improve the outcome of NORSE. The patient also reported neurophysiology outcomes such as a state of confusion and frequent non-convulsive seizures. Cerebrospinal fluid (CSF) analysis is useful in the diagnosis of PACNS and the findings showed an increased level of protein. 37
The incidence of SE or prolonged seizures is more in older than younger populations, which carry a high risk of mortality and morbidity. This was observed in the study, which aimed to assess the outcome of SE in 121 patients and risk factors including age, pre-existing epilepsy, and comorbidities during the follow-up. The mortality rate was statistically significant among an older population (53.7%; p <0.0001) mainly due to co-morbidities such as stroke, tumor, and infection. Focal, generalized & combined types of epilepsy were reported in 67 (50%), 47 (35%), and 21 (16%) patients, respectively, and 9 (7%) patients had NCSE. 27
In refractory status epilepticus (RSE) condition, seizures do not respond to treatment therapy and persist for longer than 60 minutes. 1, 38 The RSE condition increases hospitalization and mortality rates. A retrospective cohort study conducted in New York, United States, aimed to assess the incidence, risk factors, and effect on the outcome of RSE in 74 SE patients. Of 74 SE patients, 26 (35.1%) were RSE, and 57 (77.0%) were non-RSE. Seizure duration, length of hospital stay, and the mortality rate was higher in the RSE than non-RSE patients (20.1 hours vs 2.5 hours; p<0.001, 32.5 days vs. 1.0 days; p<0.001, and 23% vs. 14%; p = 0.31, respectively). The most commonly reported complications (> 50%) in RSE patients were respiratory failure (88%; p = 0.02), fever (81%; p = 0.004), pneumonia (65%; p = 0.004), and hypotension (65%; p < 0.001; Figure 5: Treatment Option for Status Epilepticus Patients) and non-RSE patients reported were respiratory failure (63%; p = 0.02) and tachycardia (86%; p = 0.56). 39
In super-refractory SE (SRSE) condition, SE continues for more than 24 hours after the onset of treatment. The SRES condition increases mortality and morbidity rate and requires immediate treatment. 40, 41, 42, 43 A retrospective analysis was conducted aimed to assess the clinical symptoms and associations between clinical characteristics of 5 SRSE patients in India. Out of 5 patients, 4 had ventilator-associated pneumonia, 2 had metabolic disturbance, and 2 died due to increased cerebrospinal fluid (CSF) protein and sepsis. 44 A few other cases of SRES revealed morbidities like pneumonia, sepsis, bilateral brain abnormalities, 5-8 seizures per day, and residual neurological deficits. 45, 46 Acid-base disturbance occurs when acids and bases in the human body
become abnormal that alters the normal pH of the blood. In a retrospectively study conducted in 38 SE patients, acid-base abnormalities were observed in 32 (84%) patients. The most commonly reported acid-base abnormality was respiratory acidosis (42%). 47
Rhabdomyolysis (severe muscle damage) was also observed in the SE patients. This was confirmed by one case study of a 21-year man who was hospitalized for SE and had increased uric
acid in his blood. He was diagnosed with rhabdomyolysis due to SE and later he developed acute kidney failure. 48
SE requires rapid treatment to prevent systemic and neurologic pathology. 9 For this, anti-seizure drugs are effective against SE conditions. Including treatment options, initial management of the SE condition is also necessary which include checking airway status, blood pressure, cardiac rhythm, circulatory support, maintaining adequate ventilation, and secure IV access in large veins during seizure activity to prevent future medical complication. 49 As various studies identified anti- seizure drugs for the management of SE, discussed below:
First-line treatment: Benzodiazepines (BZD) such as lorazepam, clonazepam, diazepam, and midazolam are effective drugs used for the treatment of prolonged seizures in SE patients. The BZD is also considered as first-line treatment for SE management.50, 51 however inadequate dose
of BZD can lead to the progression of RSE or may increase the tendency of coma in NCSE patients (Table 3). 52 Emergency medical service protocols in California define a few guidelines about the doses of benzodiazepines. The guidelines suggest a dose of the BZD drugs (0.1 mg/kg) should be administered to the SE patients as per their body weight. 53
Second -line treatment: After first-line treatment with BZD drugs, recurrent SE patients treated with second-line therapies ie, levetiracetam (LEV), fosphenytoin (FPHT), valproate (VPA), and carbamazepine (CBZ). The LEV drug was more effective and safe for the prevention of recurrent seizures in SE patients than FPHT after following the BZD treatment. 54, 55, 56 A 20 years male with SE was initially treated with IV benzodiazepines, ie, 10 mg IV diazepam and IV lorazepam 4 mg (repeated after 5 minutes). When the administration of IV benzodiazepines became ineffective
then alternative anticonvulsant treatments, ie, phenobarbital and phenytoin were given for the treatment of continuing seizures. 57
Intravenous (IV) phenytoin is used as a second-line treatment against SE, but intramuscular fosphenytoin was well tolerated and delivered faster than IV phenytoin for the treatment of acute seizures and tonic-clonic SE. 58 Including this, IV midazolam also used as a second-line treatment for pediatric SE. But, when midazolam is compared with FPHT, then both drugs have similar efficacy. Although midazolam therapy treated the SE pediatric without barbiturate coma therapy (BCT) while FPHT required BCT. Mechanical ventilation is more frequently reported in the midazolam than FPHT therapy (32.0% vs. 4.7%, p = 0.01). 59 Including this, fosphenytoin can be given as a maintenance medication at a dose of 18 to 20 mg/kg to the SE patients. Phenobarbital at a dose of 10 to 20 mg/kg, up to 100 mg/min can be given to the SE patients with cardiac rhythm disturbances. 47
A 21-year old male diagnosed with SE associated with Wilson disease was admitted to the intensive care unit (ICU) and treated with lorazepam (0.1 mg/kg IV) and phenytoin (20 mg/kg bolus IV followed by 6 mg/kg IV as maintenance dosages). The condition was improved and at 3 months follow-up, the patient showed signs of recovery. 60
Benign epilepsy with centrotemporal spikes (BECTS) is a common form of childhood epilepsy, and usually, it can be cured before 16 years. A case study of a 16-year-old girl reported propofol medication-induced RSE in patients with BECTS. Her prolonged seizure that lasted for about 14 hours was controlled with diazepam (4 mg/h), propofol (6 mg/kg/h), and VPA (2400 mg/d IV injection). Then she received VPA (800 mg/d po), oxcarbazepine (600 mg/d po), and LEV
(1000 mg/d po). On Day 17, she was discharged without any seizure recurrence during 3 months of follow-up. 61
Seizure activity in RSE patients can be improved with parenteral phenobarbital (dose 5 to 19.8 mg/kg) without causing any significant complications. 62 In addition, treatment with phenobarbital improved the short-term outcome and decreased the hospital stay of neonates with SE. 63 Phenobarbital terminated the seizure activity faster than parenteral phenytoin (p <0.0001). Therefore, phenobarbital can be safely & effectively given to infants for the management of refractory CSE. 64 Hypothermia (temperature: 31-350C) using an endovascular cooling system appears to be promising as an alternative to other agents as it has demonstrated a marked reduction in seizure activity in RSE patients. However, a further study is required to better understand its safety and efficacy due to the observed adverse events such as shivering and coagulopathy. 65
The SRSE patients who did not respond to IV VPA, LEV, lacosamide, thiopental, and midazolam can be improved with 4 mg or 8 mg dose of perampanel. 66 A case study of a 28-year old female diagnosed with SRSE recovered with 3 cycles of midazolam (3 mg/kg/hr), 2 cycles of thiopentone (6 mg/kg/hr), methylprednisolone, IV immunoglobulin and acyclovir. 67
A case study of a centenarian woman diagnosed with a generalized tonic status epilepticus (TSE) condition. Initially, she failed to respond to the anti-seizure drug therapy (LEV and VPA), and later, her seizure was controlled with lacosamide. 68
Epilepsy foundation Recommended Guideline for SE Management. 47
The Epilepsy Foundation has recommended guidelines for the management of SE patients which are discussed below:
There are various drugs available against the SE but are effective only when SE patients are treated immediately after the seizure activity because prolong seizure activity can increase neurological dysfunction or permanently damage the neurological system. Even after successful treatment, SE can be recurrent, or sometimes, SE patients did not respond to standard treatment. Therefore it is necessary to develop an effective treatment against SE, which prevents the recurrence of SE as well as rapidly abrupt seizure activity. For this, few preclinical studies have identified some drugs against refractory SE, which effectively cease the seizure activity than the standard treatment. The future recommended treatment options for the treatment of SE condition are discussed below and presented in (Table 4).
Brexanolone (SAGE-547) is a formulation of allopregnanolone (neuroactive steroid) which is under the developing stage (Phase 3) as adjunctive therapy for the treatment of SRSE condition. It effectively controls seizure in SRSE patients without causing any serious side effects. 69, 70 Ketamine is a strong N-methyl-d-aspartate glutamate receptor antagonist that is in Phase 3 for the treatment of refractory CSE, which may be completed by April 2020. 71, 72
Few preclinical studies also suggested drugs against SE conditions. Moreover, SE patients are already treated with LEV as a second-line treatment. But in the preclinical study, when LEV was given in rectal mode to the dogs, then this drug showed good control on seizure activity than standard treatments (IV/rectal diazepam and IV phenobarbital). 73 Another pre-clinical study evaluated novel anticonvulsants/neuroprotectants drugs such as scopolamine, memantine, and phenobarbital in the benzodiazepine refractory nerve agents induced SE. This study found that scopolamine effectively terminated the seizure activity more effectively than memantine, while phenobarbital delayed the seizure termination. 74
In conclusion, SE conditions can cause severe adverse outcomes, which could lead to a high mortality rate. The neurological complications were considered the most common adverse outcome in SE patients. Other adverse outcomes reported were respiratory failure, hypotension, septic shock, renal failure, and rhabdomyolysis. All these complications occurred when SE patients have delayed the treatment after diagnosis or are sometimes unable to respond to primary treatment. The worst outcomes of SE were linked to old age, etiology, NCSE, and focal status epilepsy.
This review article highlights the need for regular follow-up of patients. Moreover, further research and randomized controlled studies are required to develop an effective treatment of SE.
Copyright © 2025 All Rights Reserved