Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2023

Open Access 01-12-2023 | Status Epilepticus | Research

Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation

Authors: Sira M. Baumann, Pia De Stefano, Paulina S. C. Kliem, Pascale Grzonka, Caroline E. Gebhard, Oana E. Sarbu, Gian Marco De Marchis, Sabina Hunziker, Stephan Rüegg, Andreas Kleinschmidt, Jérôme Pugin, Hervé Quintard, Stephan Marsch, Margitta Seeck, Raoul Sutter

Published in: Critical Care | Issue 1/2023

Login to get access

Abstract

Background

Conflicting findings exist regarding the influence of sex on the development, treatment, course, and outcome of status epilepticus (SE). Our study aimed to investigate sex-related disparities in adult SE patients, focusing on treatment, disease course, and outcome at two Swiss academic medical centers.

Methods

In this retrospective study, patients treated for SE at two Swiss academic care centers from Basel and Geneva from 2015 to 2021 were included. Primary outcomes were return to premorbid neurologic function, death during hospital stay and at 30 days. Secondary outcomes included characteristics of treatment and disease course. Associations with primary and secondary outcomes were assessed using multivariable logistic regression. Analysis using propensity score matching was performed to account for the imbalances regarding age between men and women.

Results

Among 762 SE patients, 45.9% were women. No sex-related differences were found between men and women, except for older age and lower frequency of intracranial hemorrhages in women. Compared to men, women had a higher median age (70 vs. 66, p = 0.003), had focal nonconvulsive SE without coma more (34.9% vs. 25.5%; p = 0.005) and SE with motor symptoms less often (52.3% vs. 63.6%, p = 0.002). With longer SE duration (1 day vs. 0.5 days, p = 0.011) and a similar proportion of refractory SE compared to men (36.9% vs. 36.4%, p = 0.898), women were anesthetized and mechanically ventilated less often (30.6% vs. 42%, p = 0.001). Age was associated with all primary outcomes in the unmatched multivariable analyses, but not female sex. In contrast, propensity score-matched multivariable analyses revealed decreased odds for return to premorbid neurologic function for women independent of potential confounders. At hospital discharge, women were sent home less (29.7% vs. 43.7%, p < 0.001) and to nursing homes more often (17.1% vs. 10.0%, p = 0.004).

Conclusions

This study identified sex-related disparities in the clinical features, treatment modalities, and outcome of adult patients with SE with women being at a disadvantage, implying that sex-based factors must be considered when formulating strategies for managing SE and forecasting outcomes.
Appendix
Available only for authorised users
Literature
1.
Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus–report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.PubMed
2.
Mevius A, Joeres L, Gille P, Molzan M, Foskett N, Wilke T, et al. Epidemiology, real-world treatment and mortality of patients with status epilepticus in Germany: insights from a large healthcare database. Brain Commun. 2023;5(3):fcad145.PubMedPubMedCentral
3.
Langenbruch L, Strippel C, Gorlich D, Elger CE, Moddel G, Meuth SG, et al. Occurrence of status epilepticus in persons with epilepsy is determined by sex, epilepsy classification, and etiology: a single center cohort study. J Neurol. 2021;268(12):4816–23.PubMedPubMedCentral
4.
Todorov A, Kaufmann F, Arslani K, Haider A, Bengs S, Goliasch G, et al. Gender differences in the provision of intensive care: a Bayesian approach. Intensive Care Med. 2021;47(5):577–87.PubMedPubMedCentral
5.
Hesdorffer DC, Logroscino G, Cascino G, Annegers JF, Hauser WA. Incidence of status epilepticus in Rochester, Minnesota, 1965–1984. Neurology. 1998;50(3):735–41.PubMed
6.
Knake S, Rosenow F, Vescovi M, Oertel WH, Mueller HH, Wirbatz A, et al. Incidence of status epilepticus in adults in Germany: a prospective, population-based study. Epilepsia. 2001;42(6):714–8.PubMed
7.
Wu YW, Shek DW, Garcia PA, Zhao S, Johnston SC. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology. 2002;58(7):1070–6.PubMed
8.
Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55(5):693–7.PubMed
9.
Logroscino G, Hesdorffer DC, Cascino GD, Annegers JF, Bagiella E, Hauser WA. Long-term mortality after a first episode of status epilepticus. Neurology. 2002;58(4):537–41.PubMed
10.
Waterhouse EJ, Garnett LK, Towne AR, Morton LD, Barnes T, Ko D, et al. Prospective population-based study of intermittent and continuous convulsive status epilepticus in Richmond. Virginia Epilepsia. 1999;40(6):752–8.PubMed
11.
Chin RF, Neville BG, Scott RC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol Offic J Eur Fed Neurol Soc. 2004;11(12):800–10.
12.
Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Short-term mortality after a first episode of status epilepticus. Epilepsia. 1997;38(12):1344–9.PubMed
13.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.
14.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed
15.
Baumann SM, Semmlack S, Rybitschka A, Kliem PSC, De Marchis GM, Ruegg S, et al. Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: an observational cohort study. Epilepsia. 2021;62(12):3042–57.PubMed
16.
Rossetti AO, Logroscino G, Bromfield EB. A clinical score for prognosis of status epilepticus in adults. Neurology. 2006;66(11):1736–8.PubMed
17.
Sutter R, Kaplan PW, Rüegg S. Independent external validation of the status epilepticus severity score. Crit Care Med. 2013;41:e475–9.PubMed
18.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMed
19.
Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.PubMed
20.
Sutter R, Semmlack S, Spiegel R, Tisljar K, Ruegg S, Marsch S. Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study. Eur J Neurol Offi J Eur Fed Neurol Soc. 2017;24(9):1156–65.
21.
Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.PubMed
22.
Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the american epilepsy society. Epilepsy Curr. 2016;16(1):48–61.PubMedPubMedCentral
23.
Kroeger D, Amzica F. Hypersensitivity of the anesthesia-induced comatose brain. J Neurosci Offi J Soc Neurosci. 2007;27(39):10597–607.
24.
Sutter R, Kaplan PW, Rüegg S. Outcome predictors for status epilepticus—what really counts. Nat Rev Neurol. 2013;9(9):525–34.PubMed
25.
Hosmer DW, Lemeshow S. A goodness of-fit test for the multiple logistic regression model. Commu in Stat. 1980;A9:1043–69.
26.
Novy J, Logroscino G, Rossetti AO. Refractory status epilepticus: a prospective observational study. Epilepsia. 2010;51(2):251–6.PubMed
27.
Fatuzzo D, Novy J, Rossetti AO. Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: comparison between 2009 and 2017. Epilepsia. 2018;59(7):e98–102.PubMed
28.
Beuchat I, Novy J, Rossetti AO. Newer antiepileptic drugs in status epilepticus: prescription trends and outcomes in comparison with traditional agents. CNS Drugs. 2017;31(4):327–34.PubMed
29.
Strzelczyk A, Ansorge S, Hapfelmeier J, Bonthapally V, Erder MH, Rosenow F. Costs, length of stay, and mortality of super-refractory status epilepticus: a population-based study from Germany. Epilepsia. 2017;58(9):1533–41.PubMed
30.
Belluzzo M, Furlanis G, Stragapede L, Monti F. Role of comorbidities and in-hospital complications in short-term status epilepticus outcome. Clin Neurol Neurosurg. 2017;154:13–8.PubMed
31.
Zelano J, Moller F, Dobesberger J, Trinka E, Kumlien E. Infections in status epilepticus: a retrospective 5-year cohort study. Seizure. 2014;23(8):603–6.PubMed
32.
Ong CT, Sheu SM, Tsai CF, Wong YS, Chen SC. Age-dependent sex difference of the incidence and mortality of status epilepticus: a twelve year nationwide population-based cohort study in Taiwan. PLoS ONE. 2015;10(3): e0122350.PubMedPubMedCentral
33.
De Stefano P, Baumann SM, Semmlack S, Ruegg S, Marsch S, Seeck M, et al. Safety and efficacy of coma induction following first-line treatment in status epilepticus: a 2-center study. Neurology. 2021;97(6):e564–76.PubMed
34.
Modra LJ, Higgins AM, Abeygunawardana VS, Vithanage RN, Bailey MJ, Bellomo R. Sex differences in treatment of adult intensive care patients: a systematic review and meta-analysis. Crit Care Med. 2022;50(6):913–23.PubMed
35.
Kaufmann M, Perren A, Cerutti B, Dysli C, Rothen HU, Swiss Society of Intensive Care M. Severity-adjusted ICU mortality only tells half the truth-the impact of treatment limitation in a nationwide database. Crit Care Med. 2020;48(12):e1242–50.PubMed
36.
Block L, Petzold M, Syrous AN, Lindqvist B, Odenstedt Herges H, Naredi S. Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care. Acta Anaesthesiol Scand. 2019;63(9):1210–5.PubMed
37.
Gebhard CE, Hamouda N, Gebert P, Regitz-Zagrosek V, Gebhard C, Investigators C. Sex versus gender-related characteristics: which predicts clinical outcomes of acute COVID-19? Intensive Care Med. 2022;48(11):1652–5.PubMedPubMedCentral
38.
Pelletier R, Khan NA, Cox J, Daskalopoulou SS, Eisenberg MJ, Bacon SL, et al. Sex versus gender-related characteristics: Which predicts outcome after acute coronary syndrome in the young? J Am Coll Cardiol. 2016;67(2):127–35.PubMed
39.
Thornton J. WHO report shows that women outlive men worldwide. BMJ. 2019;365: l1631.PubMed
40.
Fowler RA, Sabur N, Li P, Juurlink DN, Pinto R, Hladunewich MA, et al. Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ. 2007;177(12):1513–9.PubMedPubMedCentral
41.
Hill A, Ramsey C, Dodek P, Kozek J, Fransoo R, Fowler R, et al. Examining mechanisms for gender differences in admission to intensive care units. Health Serv Res. 2019.
42.
Jacobson S, Liedgren E, Johansson G, Ferm M, Winso O. Sequential organ failure assessment (SOFA) scores differ between genders in a sepsis cohort: Cause or effect? Ups J Med Sci. 2012;117(4):415–25.PubMedPubMedCentral
43.
Scharfman HE, MacLusky NJ. The influence of gonadal hormones on neuronal excitability, seizures, and epilepsy in the female. Epilepsia. 2006;47(9):1423–40.PubMedPubMedCentral
Metadata
Title
Sex-related differences in adult patients with status epilepticus: a seven-year two-center observation
Authors
Sira M. Baumann
Pia De Stefano
Paulina S. C. Kliem
Pascale Grzonka
Caroline E. Gebhard
Oana E. Sarbu
Gian Marco De Marchis
Sabina Hunziker
Stephan Rüegg
Andreas Kleinschmidt
Jérôme Pugin
Hervé Quintard
Stephan Marsch
Margitta Seeck
Raoul Sutter
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2023
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-023-04592-6

Other articles of this Issue 1/2023

Critical Care 1/2023 Go to the issue

Correspondence

Magic mirror on the wall, which is the best meta-analysis one of all?

Review

Acute-on-chronic liver failure: far to go—a review

Research

Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial

Correction

Correction : Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies

Research

Prone position versus usual care in hypoxemic COVID-19 patients in medical wards: a randomised controlled trial

Research

Gut microbiota composition during hospitalization is associated with 60-day mortality after severe COVID-19