CME ARTICLE Clinical features of convulsive status epilepticus: a study of 220 cases in western China L. Chen a , B. Zhou a , J. M. Li a , Y. Zhu a , J. H. Wang a , J. W. Sander b,c , H. Stefan d and D. Zhou a a Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; b Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; c SEIN-Epilepsy Institute in the Netherlands, Heemstede, The Netherlands; and d Department of Neurology, Center of Epilepsy (ZEE), University of Erlangen-Nuremberg, Erlangen, Germany Keywords: aetiology, clinical charac- teristic, convulsive status epilepticus, prognosis, treatment gap, western China Received 30 June 2008 Accepted 17 October 2008 Background and purpose: Convulsive status epilepticus (CSE) is the most common and life-threatening form of status epilepticus (SE). The aim of this study was to describe the clinical features of CSE in western China. Methods: Convulsive status epilepticus patients hospitalized from January 1996 to October 2007 were prospectively observed. Logistic regression was used to identify predictors of prognosis. Results: The average age of CSE patients (n = 220) was 37.5 years (SD 20.31), 50% of the patients had a history of epilepsy. The primary cause of CSE was central nervous system infection (32.7%), followed by discontinuation or reduction of antiepileptic drugs (AEDs; 15.5%). The median duration of CSE was 5 h and median duration of seizures before treatment was 2 h; both were longer in rural patients than in urban patients (P < 0.05). The fatality rate on discharge was 15.9%. Logistic regression analysis showed the duration of CSE [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07], a history of epilepsy (OR 0.35, 95% CI 0.14–0.89), and respiratory depres- sion (OR 5.96, 95% CI 2.49–14.24) were independent predictors of CSE prognosis. Discussion: Central nervous system infection and AEDs withdrawal in epilepsy pa- tients were the most important causes of CSE. There is a large gap between antiepi- leptic therapy in China and European Status Epilepticus guidelines. Introduction Status epilepticus (SE) is a major neurological emer- gency with significant morbidity and mortality (3–46%) [1–11]. It is classified as convulsive (CSE) or non-con- vulsive status epilepticus (NCSE). NCSE is defined as a mental status changes from baseline of at least 30 min duration associated with continuous or near continuous ictal discharges on electroencephalography (EEG) [12]. However, CSE is defined as a tonic, clonic, or tonic– clonic seizure, or two or more such seizures between which consciousness was not regained, which lasted for at least 30 min [13]. As CSE is the most common form of SE [14] and as emergency EEG is not always avail- able in mainland China, we focused on CSE which could be more easily diagnosed on clinical grounds. In recent years, research into SE in China has focused on its treatment using retrospective methods; however, sample sizes were small and the studies did not reflect the current status of SE in mainland China. We report a prospective observation analysing the clinical features and prognosis of patients with CSE and discuss the results, comparing with data from the United States and Europe. Methods Subjects Between January 1996 and October 2007, all patients with CSE hospitalized in the West China Hospital of Sichuan University were registered after they gave their informed consent in a protocol approved by Ethics Committee of West China Hospital in Sichuan Uni- versity. Neurologists diagnosed all the patients mainly based on clinical symptoms and confirmed by EEG (average 15-min test). All the included patients met the Correspondence: Dong Zhou, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (tel.: +86 28 85422549; fax: +86 28 85422549; e-mail: zhoudong66@yahoo.de). This is a Continuing Medical Education article, and can be found with corresponding questions on the internet at http://www.efns.org/content.php?pid=132. Certificates for correctly answering the questions will be issued by the EFNS. 444 Ó 2008 The Author(s) Journal compilation Ó 2008 EFNS European Journal of Neurology 2009, 16: 444–449 doi:10.1111/j.1468-1331.2008.02404.x