Status Epilepticus in Shiraz, Iran: Clinical Features, Outcomes, and Economic Impact at a Referral Center

Introduction: Status Epilepticus (SE) is a common neurological emergency (1), with outcomes and prognosis significantly affected by treatment strategies (2). Intensive care may be necessary for some patients (3) highlighting the need for timely appropriate interventions to mitigate mortality, adverse outcomes, and costs(4).

Objectives: To explore the causes, outcomes, and associated costs in patients with SE to improve the quality of care through enhancements in facilities and treatment strategies.

Materials & Methods: This study examined SE patients admitted to Namazi Hospital in Shiraz, Iran, between 2021 and 2022. Data included medical record reviews and cost assessments. Categorical variables were reported as count (percent), and data analysis utilized the Mann-Whitney U test.

Results: In this study, 130 SE patients were (77; 59% males) hospitalized aged neonates to 92 years (median: 7; IQR: 34.25). Of them, 81(62%) had epilepsy, onset from neonatal to 75 years, with nearly half before age one. Notably, 14 (17.2%) patients with epilepsy (PWE) were not taking anti-epileptic drugs (AEDs), and 30 (27%) had prior SE episodes. Most cases (88.5%) had SE on admission, while the others faced SE during hospitalization. The presumed cause of SE was an exacerbation of pre-existing epilepsy (75 cases; 57.6%), frequently due to poor drug compliance (22 cases; 17%). Cerebrovascular lesions and hypoxia were other common causes; 12 cases had unknown etiology. Fifty-seven patients (43.8%) were hospitalized in the intensive care unit (ICU) in their admission course. The mortality rate was 17% (22 cases), with three (2.3%) in a vegetative state and 20 (15.3%) with varying degrees of mild to severe disabilities. The others (85 cases; 65%) recovered back to their previous health status. Hospital stays ranged from 1 to 184 days (median: 8; IQR:15). ICU-admitted patients had significantly longer stays compared to non-ICU patients (p < 0.001). Daily costs varied from 0.59 to 3971 USD (median:57.06; IQR:45.72). ICU admission incurred higher daily costs compared to non-ICU admission (p < 0.001).

Conclusion: Findings emphasize need for improved management strategies to reduce SE incidence, enhance treatment adherence among PWE, and optimize resource allocation in hospital settings to improve patient outcomes and mitigate economic burdens.

Figure 1: Outcome of patients with Status Epilepticus

Table 1: Presumed primary etiologies for Status Epilepticus. Patients may have had more than one etiology.

References:

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