Prognosis and therapy of tumor-related versus non-tumor-related status epilepticus: a systematic review and meta-analysis
1 University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, GA, The Netherlands
2 Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, GA, The Netherlands
3 Brain Center Rudolf Magnus, Department of Neurosurgery, University Medical Center Utrecht, P.O. Box 85500, Utrecht 3508, GA, The Netherlands
BMC Neurology 2014, 14:152 doi:10.1186/1471-2377-14-152Published: 19 July 2014
Status epilepticus (SE) is a medical emergency with high mortality rates. Of all SE’s, 7% are caused by a brain tumor. Clinical guidelines on the management of SE do not make a distinction between tumor-related SE and SE due to other causes. However, pathophysiological research points towards specific mechanisms of epilepsy in brain tumors. We investigated whether clinical features support a distinct profile of tumor-related SE by looking at measures of severity and response to treatment.
Systematic review of the literature and meta-analysis of studies on adult SE that report separate data for tumor-related SE and non-tumor-related SE on the following outcomes: short-term mortality, long-term morbidity, duration of SE, and efficacy of anticonvulsant intervention.
Fourteen studies on outcome of SE were included. Tumor-related SE was associated with higher mortality than non-tumor-related SE (17.2% versus 11.2%, RR 1.53, 95%-CI 1.24-1.90). After exclusion of patients with hypoxic-ischemic encephalopathy (a group with a known poor prognosis) from the non-tumor-group, the difference in mortality increased (17.2% versus 6.6%; RR 2.78, 95%-CI 2.21 – 3.47). Regarding long-term morbidity and duration of SE there were insufficient data. We did not find studies that systematically compared effects of therapy for SE between tumor- and non-tumor-related SE.
Based on – mostly retrospective – available studies, short-term mortality seems higher in tumor-related SE than in SE due to other causes. Further studies on the outcome and efficacy of different therapeutic regimens in tumor-related SE are needed, to clarify whether tumor-related SE should be regarded as a distinct clinical entity.