Adult status epilepticus at the emergency department: a retrospective chart review of a UAE tertiary care hospital

Abstract

Background: Status epilepticus (SE) is a serious neurological emergency that is associated with high mortality and morbidity. Significant data describing SE in the Middle East and North Africa regions are lacking. This study is a review of adult SE cases managed at the emergency department (ED) of Al Mafraq Hospital, Abu Dhabi, United Arab Emirates, from January 2011 to April 2016. Methods: A retrospective chart review of adult patients, who were 18 years of age and older, and who presented to the ED with SE, between January 2011 and April 2016, was conducted. Data were collected from the electronic medical records system after obtaining institutional research ethical approval. Results: Overall, 38 subjects were identified within the study period of 64 months. Demographic data reflected a male predominance of 74%. Multiple nationalities were involved, with the majority being the local Emiratis (34%). A previous history of epilepsy was present in 68% of the sample. More than three seizure episodes were observed in 66%. Generalized tonic-clonic seizure was seen in 79%. Single-agent anti-epileptic drug (AED) utilization was noted in 18% of the subjects (n = 7 subjects). In 58% of the subjects (n = 22), two agents were utilized to abort SE. 24% of the subjects required multiple agents to abort SE (n = 9). Various benzodiazepines were utilized as first-line agents in 89% of the subjects (n = 34), while the most utilized second-line agent was found to be phenytoin in 61% of the subjects (n = 23). Computed tomography of the head showed abnormal new findings in four out of 33 subjects. Only one subject had an abnormal lumbar puncture result. The control of seizures was possible in 53% of patients by using various benzodiazepines as first-line agents. There was a need for intubation in 58% of patients for airway protection. Therapeutic drug monitoring of relevant AEDs was carried out in 84% of subjects. During the admission for SE, one patient died. Conclusion: The sample reflected male Emirati predominance. There was consistency in ED management with favorable outcomes. Tools to assess nonadherence in similar samples need to be further developed. We hope that this would stimulate further research in the region and mobilize resources to develop preventive strategies. [SJEMed 2021; 2(1.000): 42-47]

Keywords

• status epilepticus
• epilepsy
• medication adherence
• neuroepidemiology