ETIOLOGICAL SPECTRUM OF ADULT PATIENTS PRESENTING WITH STATUS EPILEPTICUS

Background: Status epilepticus (SE) is one of the most critical neurological emergencies with significant morbidity and mortality. Its prevalence and clinical characteristics vary globally due to regional healthcare access, comorbidities, and precipitating factors. In developing nations like Nepal, there are limited data reported on Status Epilepticus presentation, etiologies and outcomes. Methods: A hospital-based, observational, cross-sectional descriptive study was conducted at Nobel Medical College Teaching Hospital, Biratnagar, from July 2022 to June 2024. Ninety-six consecutive adult patients (≥18 years) diagnosed with SE were included based on International League Against Epilepsy (ILAE) criteria. Sociodemographic characteristics, clinical findings, laboratory parameters, neuroimaging, and electroencephalography (EEG) results were analyzed using SPSS v16. Results: The mean age of patients was 46.1±18 years, with a male predominance (58.4%). Common comorbidities were epilepsy (28.1%), hypertension (21.9%), and diabetes mellitus (19.8%). History of substance use was present in 48.9%. Generalized convulsive Status Epilepticus (GCSE) accounted for 51% of cases and Nonconvulsive Status Epilepticus (NCSE) was observed in 19% cases. Stroke (21.9%) and central nervous system infections (20.8%) were leading etiologies. Abnormal EEG was observed in 23.9% cases, and abnormal neuroimaging was found in 34.4% cases. The most frequent complications were physical injuries (30.2%) and aspiration pneumonia with hypoxia (22.9%). Refractory Status Epilepticus occurred in 21.9% of cases and super-refractory Status Epilepticus was observed in 9.4%. Mortality was 8.3% and recurrence during hospitalization was seen in 11.4%. Conclusion: Status Epilepticus was more common in non-epileptic adults without prior history of seizure, predominantly presenting as generalized convulsive Status Epilepticus. Stroke was the most common etiology, followed by Central Nervous System infections and alcohol withdrawal seizure. Most patients had favorable clinical outcomes with appropriate management, though mortality and recurrence rates remained clinically significant.