Prevaunce of generalised convulsive statos epilepticus in patients aomitted to kenyaua national hospital uno the short term outcomes
Background: Generalized Convulsive Status Epilepticus (GCSE) is a sub-group of status epilepticus that is accompanied by visible body movements and loss of consciousness. It has a high complication rate including disability or death. Generalized convulsive status epilepticus is known to occur in both known epileptics and non epileptics, where it may be a manifestation of another underlying primary cause. Other factors that have been shown to influence outcomes in patients with GCSE are age and the underlying primary etiology. No studies have been done in Africa hence its magnitude and its influence on patient’s outcomes is unknown. Objectives: This prospective study was primarily aimed at determining the prevalence of GCSE in patients admitted to KNH and the length of admission. Secondary objectives were to document the primary etiological causes and treatment given to these patients. Study design: This is a longitudinal prospective study. The subjects were screened and those fitting the criteria for GCSE recruited and followed up to either death or discharge. Study period: The study was carried out over a three calendar month period between 1/1/2006 and 1/4/06 both days inclusive. Sampling method: Patients were recruited consecutively. Study location: The study was carried out at Kenyatta National Hospital. The wards involved included; all medical wards, all surgical wards, the obstetric and gynecology wards, the maternity unit, the renal unit, the burns unit, the intensive care unit and the high dependency unit. Methodology: All patients admitted to KNH between January and April 2006 with suspected convulsions, coma or confusional states were screened and those with GCSE recruited. They 11 were followed up on a daily basis with documentation of the primary etiology, investigations and treatment given till death or discharge. Approval to carry out the study was obtained from the KNH ethics and research committee. Participation was on a voluntary basis following an informed written consent. Results: The prevalence of GCSE was 0.48% of all patients admitted to KNH. Males were 62% while females accounted for 38% of the study population. The mean age was 28.9 years with a median of 27 years. 62% we referral cases having been seen and attended to at a peripheral health facility. The mean in-hospital stay was 16.83 days. Persons living with epilepsy accounted for 40% of the GCSE while infectious causes accounted for 38% of the primary causes of GCSE. The crude case fatality rate for GCSE is 16% with infections being most important cause of death. Conclusions: The local prevalence of GCSE is high occurring at a lower age group compared to data from western studies. It leads to a prolonged in-hospital stay which may lead to an increase in both direct and indirect medical costs. Non adherence to AEDs and infections are the most common causes of GCSE. Infections especially HIV\AIDS related opportunistic infections were the primary diagnosis associated with 80% of mortalities in GCSE patients.