Prognosis

In-hospital mortality and predictors

Overall mortality associated with status epilepticus approaches 20% and does not appear to be changing with time.[6]​[7]​​[45][46] One study of patients with generalised convulsive status epilepticus of all ages reported an in-hospital mortality rate of 3.45%.[47] Predictors of mortality included older age, higher comorbidity index, use of mechanical ventilation, and hypoxic brain injury. Despite changes in management, epidemiological studies have not shown a marked change in status epilepticus-related mortality rates in high-income countries over the past decades, although reported rates are variable across studies.[46] Numerous other studies have found acute symptomatic aetiology (such as cerebrovascular accidents or post-anoxic injuries) and longer duration of status epilepticus to predict a poorer prognosis.[46][48] Alcohol-related or poor-compliance-related status epilepticus carries a more favourable outcome than status epilepticus of other causes, but recovery of these patients is usually marked by a prolonged post-ictal state.[8][49]

Long-term follow-up

Long-term outcomes of status epilepticus vary significantly according to the underlying aetiology, duration of seizures, age, sex, medical comorbidities, incidence of in-hospital complications, and treatment location.[50] One study reported that 7 of 8 survivors of refractory status epilepticus (treated with a standardised protocol of pentobarbital coma) remained stable for a mean 2.9 years following hospital discharge.[51] A subsequent report noted a 1-year recurrence rate of 17% for paediatric status epilepticus.[52] Patients recovering from status epilepticus often continue to have neurological deficits, especially in memory and other cognitive areas.[50] This is likely to be secondary to excitotoxic injury of one or both hippocampi.[53]

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