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To the Editor:
We read the article by Koubeissi and Alshekhlee with interest.1 The overall case-fatality of 3.43% appears low compared to previous studies focusing on the same condition because postanoxic patients (who have a poor outcome) were included. Estimation of disease-specific mortality has a major impact on treatment strategy and health policy.
Considering hospital-based cohorts, which should come closer to the population studied by Koubeissi and Alshekhlee, a Turkish series found a mortality of 21%,2 and a US study 13% (restricting analysis on generalized convulsive status epilepticus [GCSE]).3 In a prospective, in-hospital series currently being undertaken in Lausanne, mortality of GCSE is 30%. Although the absolute numbers are much lower than Koubeissi and Alshekhlee’s cohort and the CIs wide, this difference appears important since these studies excluded postanoxic patients.
A possible modifying factor in the study of Koubeissi and Alshekhlee may be represented by the exclusion of “subtle status,” which often follows GCSE4 and has a significant mortality. Furthermore, in a California population-based study including anoxic subjects, the overall case-fatality was 10.7%, declining to 3.5% if analysis was restricted to patients with GCSE as the principal discharge diagnosis.5 This suggests that …
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