Stato di male epilettico: Quando la valutazione neurologica urgente è davvero tale. Presentazione, caratteristiche EEG ed outcome di pazienti valutati in ambiente ospedaliero

Status epilepticus (SE) is a neurological emergency with a high morbidity and mortality. Our goal was to analyse clinical presentations, EEG features and outcome of patients referring to our neurological emergency practice for SE. We retrospectively reviewed the clinical data and the EEGs of patients who underwent emergency neurological evaluation over a 2-year period (2006-2007) for suspected enduring seizures, acute confusional state or altered mental state. All cases with a confirmed diagnosis of SE and EEG monitoring were selected. We collected data about 58 patients (28 males and 30 females). Non-convulsive status epilepticus (NCSE) was predominant (65% of patients). Pre-existing epilepsy was found in 40% of cases. The most common causes of SE were stroke and metabolic diffuse diseases, followed by CNS neoplasm and diffused ischaemic encephalopathy. Intravenous BDZs were given to 70% of patients; the majority (46%) of patients were treated with i.v. Valproate (VPA) as second line AED with a successful control of SE; a percentage of 15% was treated immediately with i.v. VPA according to medical judgment. Mortality was 22% after 30 days and 33% after 90 days. In conclusion, NCSE prevails in hospitalised patients and is associated with a high mortality rate, as it usually is the complication of a severe neurological or systemic disease. The importance of VPA as a treatment for SE is growing, especially in older patients with multiple co-morbidity.