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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Johan Zelano, University of Gothenburg
- Second opponent: Associate Professor Leena Kämppi, University of Helsinki
- Third member and chair of the evaluation committee: Professor II Einar Osland Vik-Mo, University of Oslo
Chair of the Defence
Professor II Bjørnar Hassel, University of Oslo
Principal Supervisor
Senior Consultant Kjell Heuser, Oslo University Hospital
Summary
Status epilepticus is a life-threatening neurological emergency with an overall mortality of about 20%. Its heterogeneity makes both diagnosis and outcome prediction challenging for individual patients. In recent years, several prognostic scores combining clinical factors have been developed to estimate mortality risk, and new electroencephalographic (EEG) criteria have been proposed for diagnosing non-convulsive status epilepticus.
The aims of this thesis were twofold: first, to evaluate the external validity of two prognostic scoring systems—the Status Epilepticus Severity Scale (STESS) and the Epidemiology-based Mortality in Status Epilepticus (EMSE)—in a retrospective cohort of 151 patients with status epilepticus at Oslo University Hospital; and second, to assess the validity of the new EEG criteria in a prospective cohort of 469 patients referred for possible non-convulsive status epilepticus.
In the retrospective cohort, in-hospital mortality was 9%, lower than typically reported, likely reflecting a lower proportion of acute symptomatic causes. Otherwise, patient characteristics were comparable to those in published studies. Among the prognostic tools, EMSE—based on etiology, age, comorbidities, and EEG findings—showed the best predictive accuracy for mortality (AUROC 0.86), while STESS showed moderate accuracy (AUROC 0.73).
In the prospective cohort, 53 patients were diagnosed with non-convulsive status epilepticus. The new EEG criteria demonstrated high sensitivity (94%) but insufficient specificity (77%), limiting their ability to reliably distinguish true cases from mimicking conditions.
In conclusion, prognostic scoring systems such as EMSE and STESS may be valuable in identifying patients at increased risk of death both for clinical management and research. However, the new EEG criteria currently lack the specificity required for confirmatory diagnosis in clinical practice.
Additional information
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