Sex-specific differences in neurological emergencies such as Status epilepticus (SE) remain understudied despite growing recognition of gender disparities in medicine. This study aimes to investigate sex-related differences in etiology, diagnostics, treatment, and outcomes among patients with SE. The investigators conducted a retrospective analysis of 779 patients treated with SE at Marburg University Hospital between 2011 and 2023.
Study Type
OBSERVATIONAL
Enrollment
779
Age at SE Onset
Age in years at the time of SE onset as documented in the medical record.
Time frame: Baseline (day 1)
Diagnosis of SE Subtype
Classification of SE subtype based on clinical presentation and EEG findings, documented in the medical record. Categories include absence SE, generalized tonic-clonic SE, SE with complex focal seizure. Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
Semiology: Focal vs. Generalized
Seizure semiology classified as focal or generalized based on clinical presentation and EEG documentation in the medical record Categories: focal; generalized Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
Non-convulsive SE
Occurrence of non-convulsive SE, classified according to clinical and EEG findings as documented in the medical record. Categories: convulsive; non-convulsive Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
History of Epilepsy Prior to SE
Presence or absence of a previously established epilepsy diagnosis, as documented in the medical record before the index SE event. Categories: yes / no Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: Baseline (day 1)
Guideline-based Treatment of SE
Adherence to evidence-based guideline recommendations for the stepwise treatment of SE. Guideline adherence will be evaluated according to the following treatment algorithm (Rosenow and Weber, 2000): 1. Initial treatment with sufficient doses of intravenous lorazepam, intramuscular or intranasal midazolam, or intravenous diazepam. 2. Escalation to intravenous valproic acid or levetiracetam, and if needed, phenytoin or lacosamide. 3. For refractory SE, intensive care unit (ICU) admission with intubation and administration of intravenous anesthetics (propofol, midazolam, or thiopental). Categories: treatment according to guidelines; treatment not according to guidelines Aggregation method / Unit of measure: Number and percentage of participants (n, %)
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Time frame: During hospital stay, maximum 30 days
Intubation During Treatment of SE
Requirement for endotracheal intubation as part of the management of SE, documented in the medical record. Intubation was typically performed in the context of refractory SE and/or administration of intravenous anesthetics. Categories: intubated; not intubated Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
History of Epilepsy Surgery
Documentation of whether the patient had undergone epilepsy surgery prior to the index SE event, as recorded in the medical history. Categories: previous epilepsy surgery; no previous epilepsy surgery Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: Baseline (day 1)
Length of Hospital Stay
Duration of hospitalization in days for the index admission due to SE, documented in the medical record. Data will be summarized as mean and standard deviation (SD). Unit of measure: Days (mean, SD)
Time frame: Up to 100 days
Availability of Brain MRI During Hospital Stay
Documentation of whether a brain MRI was performed and available for diagnostic evaluation during hospitalization for SE. Categories: MRI available; MRI not available Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
Time to Brain MRI After SE Onset
Number of days between the onset of SE and the performance of a brain MRI, as documented in the medical record. Unit of measure: Days (mean, SD)
Time frame: During hospital stay, maximum 30 days
EEG with SE Available
Documentation of whether an EEG demonstrating SE was performed and available during hospitalization. Categories: EEG available; EEG not available Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: During hospital stay, maximum 30 days
EEG Control Available
Documentation of whether a follow-up EEG (control EEG) was performed after the initial EEG confirming SE, as recorded in the medical record. Categories: EEG control available; EEG control not available Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: From hospital stay through follow-up (up to study completion, an average of 1 year)
Functional Outcome at Discharge (mRS)
Functional status at hospital discharge measured by the modified Rankin Scale (mRS) (mRS, range 0-6, where 0 = no symptoms and 6 = death). Unit of measure: mRS score (mean, SD)
Time frame: Through study completion, an average of 12 days
Discharge Destination
Place of discharge following hospitalization for SE. Categories: home; rehabilitation; another clinic; deceased Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: Through study completion, an average of 12 days
Survival After One Year
Vital status one year after the index SE event, ascertained from medical records. Categories: alive; deceased Aggregation method / Unit of measure: Number and percentage of participants (n, %)
Time frame: One year after SE onset
Total Costs of Hospital Stay
Total costs of hospitalization for SE as documented in hospital billing records. Unit of measure: Euro (mean, SD)
Time frame: Through study completion, an average of 12 days
Antiseizure Medication (ASM) Use Prior to SE
Documentation of chronic ASM treatment prior to the index SE. Categories: yes; no Unit of measure: n, %
Time frame: Baseline (day 1)
Number of Distinct ASMs Prior to SE
Number of different ASMs prescribed per patient prior to the index SE. Unit of measure: mean (SD)
Time frame: Baseline (day 1)
Type of ASMs Used Prior to SE
Specific ASMs used prior to SE, including brivaracetam, carbamazepine, clobazam, clonazepam, diazepam, eslicarbazepine, ethosuximide, gabapentin, lacosamide, levetiracetam, lamotrigine, lorazepam, midazolam, oxcarbazepine, perampanel, phenobarbital, phenytoin, primidone, retigabine, rufinamide, stiripentol, topiramate, valproate, vigabatrin, zonisamide. Unit of measure: n, % for each substance
Time frame: Baseline (day 1)
Prehospital Benzodiazepine Use Before SE
Documentation of whether a benzodiazepine was administered prior to hospital admission for SE. Categories: yes; no Unit of measure: n, %
Time frame: Baseline (day 1)
Number of Distinct Prehospital Benzodiazepines
Number of different benzodiazepines administered per patient prior to hospital admission for SE. Unit of measure: mean (SD)
Time frame: Baseline (day 1)
Type of Prehospital Benzodiazepines Used
Specific benzodiazepines administered prior to hospital admission for SE, including clonazepam, diazepam, lorazepam, midazolam. Unit of measure: n, % for each substance
Time frame: Baseline (day 1)
ASM Use During SE Treatment
Documentation of whether an ASM was administered during hospitalization for SE. Categories: yes; no Unit of measure: n, %
Time frame: During hospital stay, maximum 30 days
Number of Distinct ASMs During SE
Number of different ASMs administered per patient during hospitalization for SE. Unit of measure: mean (SD)
Time frame: During hospital stay, maximum 30 days
Type of ASMs Used During SE
Specific ASMs administered during hospitalization for SE, including brivaracetam, carbamazepine, clobazam, clonazepam, eslicarbazepine, gabapentin, lacosamide, levetiracetam, lamotrigine, lorazepam, oxcarbazepine, perampanel, phenobarbital, phenytoin, primidone, retigabine, rufinamide, stiripentol, topiramate, valproate, vigabatrin, zonisamide. Unit of measure: n, % for each substance
Time frame: During hospital stay, maximum 30 days
In-hospital Benzodiazepine Use
Documentation of whether a benzodiazepine was administered during hospitalization for SE. Categories: yes; no Unit of measure: n, %
Time frame: During hospital stay, maximum 30 days
Number of Distinct In-hospital Benzodiazepines
Number of different benzodiazepines administered per patient during hospitalization for SE. Unit of measure: mean (SD)
Time frame: During hospital stay, maximum 30 days
Type of In-hospital Benzodiazepines Used
Specific benzodiazepines administered during hospitalization for SE, including lorazepam, diazepam, midazolam, clonazepam, clobazam. Unit of measure: n, % for each substance
Time frame: During hospital stay, maximum 30 days