Social Events May Raise Risk of Status Epilepticus

Raoul Sutter, MD

Birthdays. Christmas. New Year’s Eve. All can be times for celebration, but researchers have discovered that such occasions might bring increased risks for patients with epilepsy.

These special days and other social events can precede status epilepticus (SE), seizures that last more than 5 minutes or occur in a series without a patient’s complete recovery in between, researchers from Switzerland’s University Hospital Basel have found.

“Status epilepticus is one of the most feared and life-threatening neurological emergencies, with an incidence of 15 to 20 per 100,000 per year,” the study’s authors wrote. “Our findings support the hypothesis that periodic social events in adults may be associated with an increase in SE.”

While as many as one-fifth of adults with epilepsy wind up in hospital emergency rooms each year, there’s little data to document whether status epilepticus is associated with social events, the researchers said. To investigate, corresponding author Raoul Sutter, MD, Medicine and Department of Neurology, University Hospital Basel, Basel, Switzerland, and colleagues assessed the medical records of patients over 18 years old who were admitted to the hospital from 2005 to 2015.

The team analyzed the records of 409 patients with SE, whose median age was 66. The researchers considered clinical and electroencephalographic data and calculated the number, etiologies, and outcome of SE over time. The retrospective study showed that the period immediately following social events was crucial. Total SE events, as well as SE in patients with known epilepsy, peaked within 2 weeks following Christmas, New Year’s Eve, the Swiss national holiday on August 1, carnival (Mardi Gras), and the patient’s birthday.

After 2 weeks, SE incidents decreased with each additional day. There was no association between the time between SE and a social event and the patient’s outcome—in-hospital death, a return to baseline in survivors, or no return to baseline in survivors.

“The median number of SE was significantly higher in the first 2 weeks following periodic social events compared to all other weeks,” the authors wrote in the study published in Epilepsia.

Among the 62 patients who developed SE within 2 weeks following a special event, 44 were admitted to the hospital with status epilepticus. Of the 44 admitted with SE, 20 had previously known epilepsy. The remainder developed SE during their hospital stay.

In order to explore potential causes, the authors zeroed in on a patient’s behavioral changes around key events. Holidays and special occasions are often accompanied by alcohol consumption and withdrawal, changes in sleep patterns, and non-compliance with anti-seizure drugs, the team wrote. Among patients with underlying epilepsy, the researchers looked at confirmed drug withdrawal and the presence of brain conditions.

“Remarkably, a large proportion of patients developing SE close to social events had underlying epilepsy, no regular intake of ASDs [antiseizure drugs] and no acute brain lesions as the underlying etiology,” the authors said.

“The latter suggests that patients with epilepsy may be more susceptible to SE after having experienced social events and having undergone typical behavioral changes related to these events,’’ they added.

The authors cautioned, however, that despite the significant changes of status epilepticus incidence rate ratios following social events, the study could not determine a direct association between SE and these events.

“To what extent social events or associated behavioral changes have influenced outcome remains unclear,” they said. “Our data are insufficient to distinguish between the effects of specific mediators that are correlated to social events and the effects of social events per se.”

Further studies may help confirm such associations and explore the potential benefits of preventive interventions, the authors suggested.

In the meantime, clinicians should alert patients with epilepsy of the association between status epilepticus and social events and instruct them on preventive measures such as restricting alcohol intake, avoiding sleep deprivation, and complying with anti-seizure medications, the team advised.