De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.

<h4>Background</h4>Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available.<h4>Aims</h4>The aim of t...

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Autores principales:	Alba García-Villafranca, Lucía Barrera-López, Marta Pose-Bar, Elva Pardellas-Santiago, Jonathan G Montoya-Valdés, Emilio Paez-Guillán, Ignacio Novo-Veleiro, Antonio Pose-Reino
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6aa11cc5cc3c4a22a53819cb68960365
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spelling	oai:doaj.org-article:6aa11cc5cc3c4a22a53819cb689603652021-12-02T20:16:52ZDe-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.1932-620310.1371/journal.pone.0258602https://doaj.org/article/6aa11cc5cc3c4a22a53819cb689603652021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258602https://doaj.org/toc/1932-6203<h4>Background</h4>Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available.<h4>Aims</h4>The aim of the present study was to examine daily clinical practice and evaluate factors that may influence the prognosis of NCSE in non-epileptic medical inpatients.<h4>Methods</h4>We conducted a retrospective analysis including patients admitted by any cause in an Internal Medicine ward. All patients with compatible symptoms, exclusion of other causes, clinical suspicion or diagnosis of NCSE, and compatible EEG were included. Patients with a previous diagnosis of epilepsy were excluded. We also conducted a literature review by searching the PubMed/Medline database with the terms: Nonconvulsive Status OR Non-Convulsive Status.<h4>Results</h4>We included 54 patients, mortality rate reached 37% and the main factors linked to it were hypernatremia (OR = 16.2; 95% CI, 1.6-165.6; P = 0.019) and atrial fibrillation (OR = 6.7; 95% CI, 1.7-26; P = 0.006). There were no differences regarding mortality when comparing different diagnosis approach or treatment regimens. Our literature review showed that the main etiology of NCSE were neurovascular causes (17.8%), followed by antibiotic treatment (17.2%) and metabolic causes (17%). Global mortality in the literature review, excluding our series, reached 20%.<h4>Discussion</h4>We present the largest series of NCSE cases in medical patients, which showed that this entity is probably misdiagnosed in older patients and is linked to a high mortality.<h4>Conclusion</h4>The presence of atrial fibrillation and hypernatremia in patients diagnosed with NCSE should advise physicians of a high mortality risk.Alba García-VillafrancaLucía Barrera-LópezMarta Pose-BarElva Pardellas-SantiagoJonathan G Montoya-ValdésEmilio Paez-GuillánIgnacio Novo-VeleiroAntonio Pose-ReinoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258602 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Alba García-Villafranca Lucía Barrera-López Marta Pose-Bar Elva Pardellas-Santiago Jonathan G Montoya-Valdés Emilio Paez-Guillán Ignacio Novo-Veleiro Antonio Pose-Reino De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
description	<h4>Background</h4>Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available.<h4>Aims</h4>The aim of the present study was to examine daily clinical practice and evaluate factors that may influence the prognosis of NCSE in non-epileptic medical inpatients.<h4>Methods</h4>We conducted a retrospective analysis including patients admitted by any cause in an Internal Medicine ward. All patients with compatible symptoms, exclusion of other causes, clinical suspicion or diagnosis of NCSE, and compatible EEG were included. Patients with a previous diagnosis of epilepsy were excluded. We also conducted a literature review by searching the PubMed/Medline database with the terms: Nonconvulsive Status OR Non-Convulsive Status.<h4>Results</h4>We included 54 patients, mortality rate reached 37% and the main factors linked to it were hypernatremia (OR = 16.2; 95% CI, 1.6-165.6; P = 0.019) and atrial fibrillation (OR = 6.7; 95% CI, 1.7-26; P = 0.006). There were no differences regarding mortality when comparing different diagnosis approach or treatment regimens. Our literature review showed that the main etiology of NCSE were neurovascular causes (17.8%), followed by antibiotic treatment (17.2%) and metabolic causes (17%). Global mortality in the literature review, excluding our series, reached 20%.<h4>Discussion</h4>We present the largest series of NCSE cases in medical patients, which showed that this entity is probably misdiagnosed in older patients and is linked to a high mortality.<h4>Conclusion</h4>The presence of atrial fibrillation and hypernatremia in patients diagnosed with NCSE should advise physicians of a high mortality risk.
format	article
author	Alba García-Villafranca Lucía Barrera-López Marta Pose-Bar Elva Pardellas-Santiago Jonathan G Montoya-Valdés Emilio Paez-Guillán Ignacio Novo-Veleiro Antonio Pose-Reino
author_facet	Alba García-Villafranca Lucía Barrera-López Marta Pose-Bar Elva Pardellas-Santiago Jonathan G Montoya-Valdés Emilio Paez-Guillán Ignacio Novo-Veleiro Antonio Pose-Reino
author_sort	Alba García-Villafranca
title	De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
title_short	De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
title_full	De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
title_fullStr	De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
title_full_unstemmed	De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.
title_sort	de-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: analysis of mortality related factors and literature review.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6aa11cc5cc3c4a22a53819cb68960365
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De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review.

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