Incidence and prehospital management of convulsive status epilepticus in Martinique, a French Caribbean territory

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OBJECTIVE: Status epilepticus (SE) is an acute complication that can either occur in the course of epilepsy, or reflect an acute neurological or systemic disorder. SE incidence and associated mortality vary across regions and studied populations. There are no published data for the French overseas territories, including Martinique island where the population faces significant comorbidities and socioeconomic fragility. METHODS: This was a monocentric, retrospective, observational study conducted at the University Hospital of Martinique. All patients, managed by a mobile intensive care unit (MICU) for SE between January 1 and December 31, 2019, were included. RESULTS: Out of 94 patients managed for SE by the MICU, 93 were finally included. The observed annual incidence of prehospital SE was 25.2 per 100 000 inhabitants. The median age was 65 [IQR: 50-74] years, and 69% were male. Most SE cases occurred at home (69%), 72% had a history of epilepsy, and 33% had previously experienced SE. Generalized tonic-clonic SE was the most common presentation, observed in 75 patients (81%). Causes or contributing factors were residual stroke (32%), poor treatment adherence (25%), and toxic exposures (16%). The delivered treatment by the MICU team was in accordance with national guidelines in 77% of cases, with second-line anti-seizure medications used in 46 patients (50%). Brain imaging was performed in 71% of cases, and 17% of patients underwent laboratory testing in accordance with guidelines. The median hospitalization duration was 3 [IQR: 2-8.25] days, and 13 patients (14%) died during hospitalization. SIGNIFICANCE: SE incidence is four times higher in Martinique than in mainland France, associated with a high hospital mortality. Adherence to guidelines for the emergency management of patients is not optimal, particularly regarding biological assessments and brain imaging scans. Further studies are needed to better assess SE management. PLAIN LANGUAGE SUMMARY: This study looked at people in Martinique who had status epilepticus (SE), a serious condition where seizures last too long or happen repeatedly without recovery. In 2019, 93 patients were treated by the mobile intensive care unit. SE occurred more often in Martinique than in mainland France, especially among older men. Most patients had epilepsy, and the main causes were previous stroke or missed medication. Emergency treatment usually followed national guidelines, but brain scans and lab tests were sometimes missing. SE caused many hospital deaths, showing the need to improve care and prevention.

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