Epidemiology

In Europe, the annual incidence rates of generalised convulsive status epilepticus range from 3.6 to 6.6 per 100,000 population.[5] The annual incidence rates for non-convulsive status epilepticus range from 2.6 to 7.8 per 100,000 population.[5]

In the US, the incidence of status epilepticus ranges from about 10 to 41 cases per 100,000 people per year.[6][7] In a US population-based study, ethnic minorities had a substantially higher incidence (57 per 100,000) than white people (20 per 100,000).[7]

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.[8]

Risk factors

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poor anticonvulsant therapy adherence

A common cause of status epilepticus in people with known epilepsy is drug withdrawal due to poor anticonvulsant therapy adherence.[7][9]

The possible mechanism is rebound seizures after acute withdrawal of anticonvulsant medicine.

alcohol-use disorder

Alcohol-use disorder is a known risk factor for status epilepticus (SE), which may be the first presentation of alcohol-related seizures.[16] Alcohol withdrawal is also a risk factor for SE.[10][11]

stroke

Stroke is the leading cause of SE among acute symptomatic cases.[9]

toxic or metabolic causes

Examples include disturbances in water, glucose, and electrolyte metabolism.[11]

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refractory epilepsy

Chronic or refractory epilepsy is a risk factor for developing status epilepticus. This was observed in several clinical trials involving patients with pharmacoresistant epilepsy.[17]

processes leading to direct cortical structural damage

Other than stroke (ischaemic, haemorrhagic), examples include hypoxic-ischaemic brain injury, head trauma, subarachnoid haemorrhage, tumours, brain abscess, and other brain infections (meningitis, encephalitis).[11][18]

use of restricted or recreational drugs

This includes the use of restricted or recreational drugs such as cocaine and amphetamines.[10][11][19]​​​​ Also, certain prescription drugs (e.g., theophylline, bupropion, tramadol, or isoniazid) may in rare cases precipitate status epilepticus.

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