Epilepsia, 49(4):600–607, 2008 doi: 10.1111/j.1528-1167.2008.01556.x FULL-LENGTH ORIGINAL RESEARCH Status epilepticus: Clinical presentation, cause, outcome, and predictors of death in 119 Ethiopian patients * Amanuel Amare, * Guta Zenebe, †Julie Hammack, and ‡Gail Davey * Medical Faculty, Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia; †Department of Neurology, Mayo Medical School, Rochester, Minnesota, U.S.A.; ‡School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia SUMMARY Purpose: Status epilepticus (SE) is a common neu- rological emergency with high morbidity and mor- tality. There is no study that has been conducted among Ethiopian patients with SE. The purpose of this study was to analyze clinical presentation, causes, complications, outcomes, and predictors of mortality. Methods: In this retrospective study, patients aged ≥13 year with SE were included. Medical records were reviewed and demographic and clinical data were collected. Results: Records of 119 patients were analyzed; preexisting epilepsy was found in 38.7%. Primarily generalized and focal with secondarily generalized (FWSG) seizures were identified in 60.5% and 36%, respectively. Simple partial SE occurred in 3.4%. Central nervous system (CNS) infection was the most common cause of SE in the whole group as well as in those with new onset seizure. Antiepilep- tic drug withdrawal (AEDW) was the main cause in those with preexisting seizure. One or more complications were detected in 61%. Intravenous diazepam and oral phenytoin were given to 95% and 97.5%, respectively. Case fatality was 20.2%; poor outcome occurred in 24%. Predictors of mor- tality were FWSG type, acute symptomatic etiol- ogy, stroke, systemic infection, and HIV/AIDS and its CNS complications. Idiopathic and SE due to AEDW were associated with good prognosis. Conclusions: CNS infection was the most common cause of SE in the whole group and AEDW was the major cause in patients with preexisting epilepsy. Parenteral anticonvulsants, emergency measure- ment of serum AED level, and electroencephalog- raphy for urgent diagnosis and monitoring were unavailable. Mortality was related to underlying etiologies especially HIV/AIDS and its CNS com- plications. KEY WORDS: Epilepsy, Status epilepticus, Etiol- ogy, Complication, Case fatality. Status epilepticus (SE) is a common neurological emer- gency that remains associated with a high rate of mor- bidity and mortality (Lowenstein, 1999). It has annual in- cidence rates per 100,000 population of 9.9 in French- speaking Switzerland (Coeytaux et al., 2000), 13.1–16.5 in Italy (Vignatelli et al., 2003, 2005), 15.8 in Germany (Knake et al., 2001), 18.3 in Rochester, Minnesota (Hes- dorffer et al., 1998), and 41 in Richmond, Virginia (De- Lorenzo et al., 1996). The case fatality varies from 7% to 39% (Lowenstein & Alldredge, 1993; Scholtes et al., 1994; Accepted January 24, 2008; Online Early publication February 11, 2008. Address correspondence to Dr. Amanuel Amare, P.O. Box 28797, code 1000, Addis Ababa, Ethiopia. E-mail: amanuelaw@yahoo.com Blackwell Publishing, Inc. C  2008 International League Against Epilepsy Towne et al., 1994; Logroscino et al., 1997; Sagduyu et al., 1998; Coeytaux et al., 2000; Mbodj et al., 2000; Knake et al., 2001; Garzon et al., 2003; Hui et al., 2003; Vig- natelli et al., 2003, 2005; Rossetti et al., 2006). The inci- dence and mortality rates of SE have increased in some areas in the last three decades largely due to the occur- rence of myoclonic SE after cardiac arrest, even though the 30-day case fatality has remained the same (Logros- cino et al., 2001). Mortality in SE has been related to older age, male gender, prolonged seizure duration and delay in treatment, marked impairment of consciousness, com- plications of SE, and acute symptomatic etiology (central nervous system [CNS] infection, stroke, metabolic distur- bances, anoxia). Idiopathic and antiepileptic drug with- drawal (AEDW) SE has been associated with low mor- tality. Short-term mortality after SE occurs mainly in the 600