New Score May Help Predict Outcome for Some Cases of Status Epilepticus

By Marilynn Larkin

April 25, 2022

NEW YORK (Reuters Health) - In patients with status epilepticus that is "less damaging" to the brain, a three-factor scoring system may help predict post-discharge outcomes, researchers suggest.

As reported in JAMA Neurology, Dr. Christoph Beier of Odense University Hospital in Denmark and colleagues analyzed data on adult patients with status epilepticus at centers in four European countries from 2008 to 2017, and tested a new system, called the ACD score, for predicting two-year (long-term) mortality after hospital discharge.

The ACD score represents age at onset, level of consciousness at admission, and duration of status epilepticus.

The predefined end point was two-year survival for all patients and for a subgroup of patients with status epilepticus causes that were not damaging or were less damaging to the brain - i.e., not caused by ischemic stroke, cerebral hemorrhage, cerebral infection, etc.

A total of 261 patients (mean age, 67; 51%, women) were included; of these 145 (mean age, 66; 54%, women) had status epilepticus causes that were not damaging or were less damaging to the brain.

At hospital discharge, close to 30% of patients had new moderate-to-severe neurological deficits compared with baseline.

New neurological deficits were a major predictor of two-year survival after hospital discharge (odds ratio, 5.1), regardless of etiology.

Nonconvulsive status epilepticus in coma and duration of status epilepticus were associated with the development of new neurological deficits, and the ACD score had a linear correlation with two-year survival, especially in the subset of patients with a low likelihood of brain damage.

Dr. Beier did not respond to requests for a comment, but two U.S. experts commented on the study in separate emails to Reuters Health.

Dr. Christopher Elder, assistant professor of neurology in the Division of Epilepsy and Sleep at Columbia University Medical Center in New York City, thinks the score could be clinically useful. "The ACD score is a relatively simple scoring system that providers can easily recall and apply, with a lower score predicting better long-term survival," he said.

However, he noted, "A significant caveat of this research is that it only identifies risk factors and long-term outcomes for patients with 'less damaging' causes of status epilepticus, so clinicians should be aware of the specific patients to which this data applies."

"For example, this study excludes patients with many common causes of status epilepticus, including stroke, anoxic brain injury, intracranial hemorrhage, encephalitis, brain tumors, among others," he said. "Only a small minority of patients had continuous EEG monitoring, so the duration component of this score may require some revision in the future. This also looked at adults only, so we don't know if the findings are relevant to children who experience status epilepticus."

Neurosurgeon Dr. Amir Faraji, an assistant professor at Houston Methodist, in Texas, noted, "Similar scores are routinely used with patients with stroke, intracranial hemorrhage, and/or coma. The generalizability of this study to the U.S. and beyond Western Europe, given our differences in health care systems, will need to be factored in."

Further, he said, "The definition of neurological deficit in this paper is an increase in the NIH Stroke Scale, which is more reflective of sensorimotor symptoms. In contrast, the traditional ambulatory/outpatient epilepsy patient may suffer from higher cognition or memory disabilities. This paper is therefore more restricted to inpatient admissions or critically ill patients presenting with status epilepticus with or without neurological deficits."

"Also, the mortality seen with higher (>10) scoring patients is seen within the first 100 days or so, which is typically the time period where many patients with a serious deficit, coma, or ICU admission with complications, are still in the hospital," he added. "Understanding the cause of this mortality would be important, and again may be different in terms of Western European versus American health care systems."

SOURCE: https://bit.ly/3v7QQrd JAMA Neurology, online April 11, 2022. (Editing by Christine Soares)

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