Adult convulsive status epilepticus in the developing country of Honduras

Skinner, Holly J.; Dubon-Murcia, Sofia A.; Thompson, Arnold R.; Medina, Marco T.; Edwards, Jonathan C.; Nicholas, Joyce S.; Holden, Kenton R.

doi:10.1016/j.seizure.2010.05.007

« Previous Next »Seizure: European Journal of Epilepsy
Volume 19, Issue 6 , Pages 363-367, July 2010

Adult convulsive status epilepticus in the developing country of Honduras

Holly J. Skinner
- Department of Neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Ave. Suite 307 Clinical Science Bldg., Charleston, SC 29425, USA
- Neurology Training Program, National Autonomous University of Honduras, Postgrado de Neurología, área de las torres, 5to. piso, Hospital Escuela, Blvd Suyapa, Tegucigalpa, Honduras, USA
- Holly J. Skinner D.O., formerly a neurology resident at the Medical University of South Carolina and at present she is a Clinical Neurophysiology Fellow at the University of Florida.
- Corresponding author at: Department of Neurology, University of Florida College of Medicine, HSC Box 100236, Gainesville, FL 32610-0236, USA. Tel.: +1 352 273 5550; fax: +1 352 273 5575.
Sofia A. Dubon-Murcia
- Neurology Training Program, National Autonomous University of Honduras, Postgrado de Neurología, área de las torres, 5to. piso, Hospital Escuela, Blvd Suyapa, Tegucigalpa, Honduras, USA
Arnold R. Thompson
- Neurology Training Program, National Autonomous University of Honduras, Postgrado de Neurología, área de las torres, 5to. piso, Hospital Escuela, Blvd Suyapa, Tegucigalpa, Honduras, USA
Marco T. Medina
- Neurology Training Program, National Autonomous University of Honduras, Postgrado de Neurología, área de las torres, 5to. piso, Hospital Escuela, Blvd Suyapa, Tegucigalpa, Honduras, USA
Jonathan C. Edwards
- Department of Neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Ave. Suite 307 Clinical Science Bldg., Charleston, SC 29425, USA
Joyce S. Nicholas
- Department of Medicine, Medical University of South Carolina, 135 Cannon St. Room 302M, Charleston, SC 29425, USA
Kenton R. Holden
- Department of Neurosciences, Division of Neurology, Medical University of South Carolina, 96 Jonathan Lucas Ave. Suite 307 Clinical Science Bldg., Charleston, SC 29425, USA
- Neurology Training Program, National Autonomous University of Honduras, Postgrado de Neurología, área de las torres, 5to. piso, Hospital Escuela, Blvd Suyapa, Tegucigalpa, Honduras, USA

Received 23 October 2009; received in revised form 8 February 2010; accepted 20 May 2010. published online 16 June 2010.

Abstract

Epidemiologic data on convulsive status epilepticus (CSE) is needed to develop preventative strategies. Epilepsy is one of the known risk factors for CSE. A systematic review of epidemiologic studies on status epilepticus (SE) completed in the United States and Europe reports that people with epilepsy account for less than 50% of cases of SE in all age groups. Less is known about the epidemiology of SE in developing countries including those in Central America.

A high incidence of epilepsy, widespread non-adherence to anti-epileptic drugs (AED), and common use of complementary and alternative medicines have been shown in all ages in the developing country of Honduras, Central America. In 2003, an epidemiologic study of CSE in Honduran children demonstrated it is common and exhibits a long duration until onset of treatment. The etiologies, treatment, and outcomes of CSE in Honduran adults have not been thoroughly studied. This study is a consecutive case series of 31 adult patients presenting with CSE to the adult medicine emergency department of the tertiary care “Hospital Escuela” in the capital city Tegucigalpa, Honduras. The majority (77.4%) of patients had a prior history of epilepsy. Non-adherence to AED was the most common etiology of CSE (75.0%). The mortality rate in this pilot CSE study was 14.8%, which is similar to studies from industrialized countries where mortality from status epilepticus ranged from 7.6 to 22% for all age groups. However, this rate is concerning given that CSE from epilepsy and AED non-adherence generally carries a good prognosis.

Improving AED adherence in this population appears to be the most effective approach in decreasing the rate, and possibly the mortality of Honduran adult CSE.

Abbreviations: CSE, Convulsive status epilepticus, SE, Status epilepticus, AED, Anti-epileptic drugs, ILAE, International League Against Epilepsy, IRB, Institutional Review Board, MUSC, Medical University of South Carolina, NAUH, National Autonomous University of Honduras, EEG, Electroencephalogram, NCSE, Non-convulsive status epilepticus