Changing Status Epilepticus Patterns in the COVID-19 Era: Trends and Outcomes in an Elderly Cohort
Aaron Paul1, Angela Liu1, Ritika Patel1, Marjorie Bunch2
1Albany Medical College, 2Department of Neurology, Albany Medical Center
Objective:
To evaluate whether the COVID-19 era was associated with changing trends in volume, etiologies, and outcomes of adults ≥65 presenting to a tertiary medical center in New York state with status epilepticus (SE).
Background:
The pandemic’s impacts on access to care, therapeutic adherence, and infection exposure may have altered SE presentation, severity, and outcomes in older adults.
Design/Methods:
We performed a retrospective review of adults ≥65 admitted with SE from January 1, 2017 to May 29, 2023. Cases were classified as: pre-Covid (before March 13, 2020) and post-Covid (after March 13, 2020). Quarterly case counts were compared using Welch’s test and a log-linear count model (Poisson). Cases were classified hierarchically: first as breakthrough or new onset, then mapped to a secondary etiology category. Breakthrough was defined as SE in patients with a documented prior seizure disorder or anti-seizure medication. New onset was defined as SE in patients with no documented prior seizure history or baseline anti-seizure medications. Outcomes included in-hospital mortality and length of stay (LOS).
Results:
194 encounters were identified (pre n=82, post n=112). Mean quarterly counts increased from 6.46 (pre) to 8.69 (post) (Welch p=0.061). In the pre-specific count model, the post period was associated with a 35% higher quarterly rate of SE encounters (rate ratio 1.35, 95% CI 1.01-1.78, p=0.04). While we observed no significant differences in the etiology mix pre vs post, infectious etiologies showed a trend toward higher share post (1.2% vs 7.3%, Fisher p=0.081). For secondary outcomes, breakthrough SE had a lower in-hospital mortality than new-onset SE (10.5% vs 31.4%, Fisher p=0.002) and a shorter LOS (median 5.0 vs 9.0 days, Wilcoxon p=0.0036).
Conclusions:
Our findings reflect an increased SE case burden with a trend towards infectious etiologies during the COVID-19 era. Secondary outcomes point to lower in-hospital mortality and shorter LOS in breakthrough SE patients.
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