Epidemiology
In Europe, the annual incidence rates of generalised convulsive status epilepticus range from 3.6 to 6.6 per 100,000 population.[3]Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010 Mar;17(3):348-55.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-1331.2009.02917.x
http://www.ncbi.nlm.nih.gov/pubmed/20050893?tool=bestpractice.com
The annual incidence rates for non-convulsive status epilepticus range from 2.6 to 7.8 per 100,000 population.[3]Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010 Mar;17(3):348-55.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-1331.2009.02917.x
http://www.ncbi.nlm.nih.gov/pubmed/20050893?tool=bestpractice.com
Status epilepticus can equally occur in patients with an established diagnosis of epilepsy or as the first unprovoked seizure in patients with no known history of epilepsy. In patients with epilepsy, status epilepticus is more likely to occur in those with refractory seizures of focal onset, whether or not there is known structural aetiology.[4]Hauser WA. Status epilepticus: epidemiologic considerations. Neurology. 1990 May;40(5 suppl 2):S9-S13.
http://www.ncbi.nlm.nih.gov/pubmed/2185441?tool=bestpractice.com
Risk factors
A common cause of status epilepticus in people with known epilepsy is drug withdrawal due to poor anticonvulsant therapy adherence.[5]Trinka E, Höfler J, Zerbs A. Causes of status epilepticus. Epilepsia. 2012 Sep;53 Suppl 4:127-38.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2012.03622.x
http://www.ncbi.nlm.nih.gov/pubmed/22946730?tool=bestpractice.com
[9]DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996 Apr;46(4):1029-35.
http://www.ncbi.nlm.nih.gov/pubmed/8780085?tool=bestpractice.com
The possible mechanism is rebound seizures after acute withdrawal of anticonvulsant medicine.
Alcohol-use disorder is a known risk factor for status epilepticus (SE), which may be the first presentation of alcohol-related seizures.[10]Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia. 1993 Nov-Dec;34(6):1033-7.
http://www.ncbi.nlm.nih.gov/pubmed/8243353?tool=bestpractice.com
Alcohol withdrawal is also a risk factor for SE.[6]Walker M. Status epilepticus: an evidence based guide. BMJ. 2005 Sep 24;331(7518):673-7.
http://www.ncbi.nlm.nih.gov/pubmed/16179702?tool=bestpractice.com
Stroke is the leading cause of SE among acute symptomatic cases.[5]Trinka E, Höfler J, Zerbs A. Causes of status epilepticus. Epilepsia. 2012 Sep;53 Suppl 4:127-38.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2012.03622.x
http://www.ncbi.nlm.nih.gov/pubmed/22946730?tool=bestpractice.com
Examples include disturbances in water, glucose, and electrolyte metabolism.[6]Walker M. Status epilepticus: an evidence based guide. BMJ. 2005 Sep 24;331(7518):673-7.
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Chronic or refractory epilepsy is a risk factor for developing status epilepticus. This was observed in several clinical trials involving patients with pharmacoresistant epilepsy.[11]Shinnar S. Who is at risk for prolonged seizures? J Child Neurol. 2007 May;22(5 suppl):S14-20.
http://www.ncbi.nlm.nih.gov/pubmed/17690083?tool=bestpractice.com
Other than stroke (ischaemic, haemorrhagic), examples include hypoxic-ischaemic brain injury, head trauma, stroke (ischaemic, haemorrhagic), subarachnoid haemorrhage, tumours, brain abscess, and other brain infections (meningitis, encephalitis).[6]Walker M. Status epilepticus: an evidence based guide. BMJ. 2005 Sep 24;331(7518):673-7.
http://www.ncbi.nlm.nih.gov/pubmed/16179702?tool=bestpractice.com
This includes substance use of certain restricted or recreational drugs such as cocaine and amphetamines.[6]Walker M. Status epilepticus: an evidence based guide. BMJ. 2005 Sep 24;331(7518):673-7.
http://www.ncbi.nlm.nih.gov/pubmed/16179702?tool=bestpractice.com
Also, certain prescription drugs (e.g., theophylline, bupropion, tramadol, or isoniazid) may in rare cases precipitate status epilepticus.