Risk factors for status epilepticus: a systematic review and meta-analysis_Journal of Epilepsy

Authors：

Cheliger ¹ ,  SUN Hongying ² , Celemuge ¹ , DING Xiaopeng ¹ , MAO jian ²

1. Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, China;
2. Department of Neurology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, China;

Corresponding?author：

SUN Hongying, Email: sunhongying2004@sina.com

Keywords：

Status epilepticus; Risk factors; Case-control study; Cohort study; Meta-analysis

DOI：

10.7507/2096-0247.202604004

Video：

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Objective To systematically evaluate the risk factors associated with the incidence of status epilepticus and provide evidence-based medical evidence for early identification and prevention. Methods Systematic searches were performed in databases including PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP, and CBM for studies investigating risk factors for status epilepticus. The search covered the period from database inception to December 2025. Two researchers independently performed literature screening, data extraction, and quality assessment. Meta-analysis was performed using RevMan 5.4 and Stata 18.0 software. Results A total of 10 articles were ultimately included (8 case-control studies and 2 cohort studies). The meta-analysis results indicated that a history of epilepsy [OR= 7.64, 95%CI (3.44, 17.00), P<0.000 01], poor medication adherence [OR=3.74, 95%CI(2.52,5.56), P<0.000 01], cerebrovascular disease [OR=6.01, 95%CI(3.60, 10.03), P<0.000 01], central nervous system infection [OR=4.60, 95%CI(2.58, 8.19), P<0.000 01], craniocerebral injury [OR=2.57, 95%CI(1.19, 5.55), P=0.02], abnormal background electroencephalogram activity [OR=2.98, 95%CI(1.90, 4.66), P<0.000 01], and neuroimaging (MRI) abnormalities [OR=1.98, 95%CI(1.39,2.83), P=0.000 2] were potential risk factors for status epilepticus. Conclusion History of epilepsy, poor medication adherence, cerebrovascular disease, central nervous system infection, craniocerebral injury, abnormal background electroencephalogram activity, and abnormal neuroimaging findings may be risk factors for the onset of status epilepticus. Therefore, early identification of and intervention based on these risk factors are crucial for preventing status epilepticus.

Citation： Cheliger, SUN Hongying, Celemuge, DING Xiaopeng, MAO jian. Risk factors for status epilepticus: a systematic review and meta-analysis. Journal of Epilepsy, 2026, 12(5): 391-399. doi: 10.7507/2096-0247.202604004 Copy

1.	Magro G, Laterza V. Status epilepticus: is there a stage 1 plus?[J]. Epilepsia, 2024, 65(6): 1560-1567.
2.	李袁源, 張鴻. 癲癇持續狀態診療及預后的研究進展[J]. 癲癇雜志, 2025, 11(3): 250-255.LI Yuanyuan, ZHANG Hong. Research progress on diagnosis, treatment and prognosis of status epilepticus[J]. Journal of Epilepsy, 2025, 11(3): 250-255.
3.	Haider HA. Initial management of acute seizures and status epilepticus[J]. Med Clin North Am, 2025, 109(2): 497-508.
4.	Gettings JV, Mohammad Alizadeh Chafjiri F, Patel A A, et al. Diagnosis and management of status epilepticus: improving the status quo[J]. Lancet Neurol, 2025, 24(1): 65-76.
5.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦電圖與癲癇學組. 中國成人驚厥性癲癇持續狀態診治指南(2025版)[J]. 中華神經科雜志, 2025, 58(12): 1250-1258.Chinese Society of Neurology, Chinese Medical Association; EEG and Epilepsy Group, Chinese Society of Neurology, Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Convulsive Status Epilepticus in Chinese Adults (2025 Edition)[J]. Chinese Journal of Neurology, 2025, 58(12): 1250-1258.
6.	Meziane-Tani A, Foreman B, Mizrahi MA. Status epilepticus: work-up and management in adults[J]. Semin Neurol, 2020, 40(6): 652-660.
7.	苗銳, 康靜, 王莉, 等. 癲癇持續狀態的發病危險因素分析[J]. 現代生物醫學進展, 2011, 11(10): 1881-1884.MIAO Rui, KANG Jing, WANG Li, et al. Analysis of risk factors for the onset of status epilepticus[J]. Progress in Modern Biomedicine, 2011, 11(10): 1881-1884.
8.	王藝, 張瑾, 孫道開. 小兒癲癎持續狀態危險因素的病例-對照研究[J]. 中華兒科雜志, 2002(06): 33-36.WANG Yi, ZHANG Jin, SUN Daokai. Case-control study on risk factors of status epilepticus in children[J]. Chinese Journal of Pediatrics, 2002(06): 33-36.
9.	武曉芳. 癲癇持續狀態相關危險因素分析[J]. 安徽醫學, 2015, 36(06): 712-714.WU Xiaofang. Analysis of related risk factors for status epilepticus[J]. Anhui Medical Journal, 2015, 36(06): 712-714.
10.	CAnou?-Poitrine F, Bastuji-Garin S, Alonso E, et al. Risk and prognostic factors of status epilepticus in the elderly: a case-control study[J]. Epilepsia, 2011, 52(10): 1849-1856.
11.	Sánchez Fernández I, Klehm J, An S, et al. Comparison of risk factors for pediatric convulsive status epilepticus when defined as seizures ≥ 5 min versus seizures ≥ 30 min[J]. Seizure, 2014, 23(9): 692-698.
12.	Karasalihoglu S, Oner N, Celtik C, et al. Risk factors of status epilepticus in children[J]. Pediatr Int, 2003, 45(4): 429-434.
13.	Hesdorffer DC, Shinnar S, Lewis DV, et al. Risk factors for febrile status epilepticus: a case-control study[J]. J Pediatr, 2013, 163(4): 1147-1151.
14.	Tatro HA, Hamilton LA, Peters C, et al. Identification of risk factors for refractory status epilepticus[J]. Ann Pharmacother, 2020, 54(1): 14-21.
15.	Tu TM, Loh NK, Tan NC. Clinical risk factors for non-convulsive status epilepticus during emergent electroencephalogram[J]. Seizure, 2013, 22(9): 794-797.
16.	Beuchat I, Rosenow F, Kellinghaus C, et al. Refractory status epilepticus: risk factors and analysis of intubation in the multicenter SENSE registry[J]. Neurology, 2022, 99(16): e1824-e1834.
17.	Freedman DA, Roach ES. Status epilepticus[J]. Pediatr Rev, 2023, 44(7): 383-392.
18.	Rubinos C. Emergent management of status epilepticus[J]. Continuum (Minneap Minn), 2024, 30(3): 682-720.
19.	Migdady I, Rosenthal ES, Cock HR. Management of status epilepticus: a narrative review[J]. Anaesthesia, 2022, 77(Suppl 1): 78–91.
20.	呂振, 黃華. 癲癇持續狀態相關并發癥的研究進展[J]. 癲癇與神經電生理學雜志, 2024, 33(06): 368-371.LV Zhen, HUANG Hua. Research progress on complications associated with status epilepticus[J]. Journal of Epilepsy and Neuroelectrophysiology, 2024, 33(06): 368-371.
21.	Bleck TP. Refractory status epilepticus[J]. Curr Opin Crit Care, 2005, 11(2): 117-120.
22.	Cuero MR, Varelas PN. Super-refractory status epilepticus[J]. Curr Neurol Neurosci Rep, 2015, 15(11): 74.
23.	Tian Z, Xu Y, He R, et al. Clinical characteristics and risk factors for severity and prognosis of convulsive status epilepticus[J]. Brain Behav, 2025, 15(8): e70681.
24.	Zhang L, Zheng W, Chen F, et al. Associated factors and prognostic implications of non-convulsive status epilepticus in ischemic stroke patients with impaired consciousness[J]. Front Neurol, 2021, 12: 795076.
25.	Wang D, Li M, Pan Y, et al. Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study[J]. Ther Adv Neurol Disord, 2023, 16: 17562864231214846.
26.	Betjemann JP, Lowenstein DH. Status epilepticus in adults[J]. Lancet Neurol, 2015, 14(6): 615-624.
27.	Lawson T, Yeager S. Status epilepticus in adults: a review of diagnosis and treatment[J]. Crit Care Nurse, 2016, 36(2): 62-73.
28.	Vossler DG. First seizures, acute repetitive seizures, and status epilepticus[J]. Continuum (Minneap Minn), 2025, 31(1): 95-124.
29.	Trinka E, H?fler J, Zerbs A. Causes of status epilepticus[J]. Epilepsia, 2012, 53(Suppl 4): 127–138.
30.	Brown I, Sheeran P, Reuber M. Enhancing antiepileptic drug adherence: a randomized controlled trial[J]. Epilepsy Behav, 2009, 16(4): 634-639.
31.	Valton L, Benaiteau M, Denuelle M, et al. Etiological assessment of status epilepticus[J]. Rev Neurol (Paris), 2020, 176(6): 408-426.
32.	陳庭亮, 李衛. 重型顱腦損傷合并早期癲癇持續狀態的診斷與治療[J]. 中華神經醫學雜志, 2005, 56(5): 511-512.CHEN Tingliang, LI Wei. Diagnosis and treatment of severe traumatic brain injury combined with early status epilepticus[J]. Chinese Journal of Neuromedicine, 2005, 56(5): 511-512.
33.	Singh G. Other central nervous system infections and status epilepticus[J]. Epilepsia, 2009, 50(Suppl 12): 67–69.
34.	Misra UK, Kalita J, Nair PP. Status epilepticus in central nervous system infections: an experience from a developing country[J]. Am J Med, 2008, 121(7): 618-623.
35.	Fung FW, Abend NS. EEG monitoring after convulsive status epilepticus[J]. J Clin Neurophysiol, 2020, 37(5): 406-410.
36.	Meletti S, Monti G, Mirandola L, et al. Neuroimaging of status epilepticus[J]. Epilepsia, 2018, 59(Suppl 2): 113–119.
37.	Chen D, Zhang Q, Miao H, et al. The impact of comorbidities, EEG abnormalities, and ASM use as a predicting outcomes in pediatric status epilepticus[J]. Neuropsychiatr Dis Treat, 2025, 21: 1689-1702.
38.	Zimmern V, Korff C. Status epilepticus in children[J]. J Clin Neurophysiol, 2020, 37(5): 429-433.

1. Magro G, Laterza V. Status epilepticus: is there a stage 1 plus?[J]. Epilepsia, 2024, 65(6): 1560-1567.
2. 李袁源, 張鴻. 癲癇持續狀態診療及預后的研究進展[J]. 癲癇雜志, 2025, 11(3): 250-255.LI Yuanyuan, ZHANG Hong. Research progress on diagnosis, treatment and prognosis of status epilepticus[J]. Journal of Epilepsy, 2025, 11(3): 250-255.
3. Haider HA. Initial management of acute seizures and status epilepticus[J]. Med Clin North Am, 2025, 109(2): 497-508.
4. Gettings JV, Mohammad Alizadeh Chafjiri F, Patel A A, et al. Diagnosis and management of status epilepticus: improving the status quo[J]. Lancet Neurol, 2025, 24(1): 65-76.
5. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦電圖與癲癇學組. 中國成人驚厥性癲癇持續狀態診治指南(2025版)[J]. 中華神經科雜志, 2025, 58(12): 1250-1258.Chinese Society of Neurology, Chinese Medical Association; EEG and Epilepsy Group, Chinese Society of Neurology, Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Convulsive Status Epilepticus in Chinese Adults (2025 Edition)[J]. Chinese Journal of Neurology, 2025, 58(12): 1250-1258.
6. Meziane-Tani A, Foreman B, Mizrahi MA. Status epilepticus: work-up and management in adults[J]. Semin Neurol, 2020, 40(6): 652-660.
7. 苗銳, 康靜, 王莉, 等. 癲癇持續狀態的發病危險因素分析[J]. 現代生物醫學進展, 2011, 11(10): 1881-1884.MIAO Rui, KANG Jing, WANG Li, et al. Analysis of risk factors for the onset of status epilepticus[J]. Progress in Modern Biomedicine, 2011, 11(10): 1881-1884.
8. 王藝, 張瑾, 孫道開. 小兒癲癎持續狀態危險因素的病例-對照研究[J]. 中華兒科雜志, 2002(06): 33-36.WANG Yi, ZHANG Jin, SUN Daokai. Case-control study on risk factors of status epilepticus in children[J]. Chinese Journal of Pediatrics, 2002(06): 33-36.
9. 武曉芳. 癲癇持續狀態相關危險因素分析[J]. 安徽醫學, 2015, 36(06): 712-714.WU Xiaofang. Analysis of related risk factors for status epilepticus[J]. Anhui Medical Journal, 2015, 36(06): 712-714.
10. CAnou?-Poitrine F, Bastuji-Garin S, Alonso E, et al. Risk and prognostic factors of status epilepticus in the elderly: a case-control study[J]. Epilepsia, 2011, 52(10): 1849-1856.
11. Sánchez Fernández I, Klehm J, An S, et al. Comparison of risk factors for pediatric convulsive status epilepticus when defined as seizures ≥ 5 min versus seizures ≥ 30 min[J]. Seizure, 2014, 23(9): 692-698.
12. Karasalihoglu S, Oner N, Celtik C, et al. Risk factors of status epilepticus in children[J]. Pediatr Int, 2003, 45(4): 429-434.
13. Hesdorffer DC, Shinnar S, Lewis DV, et al. Risk factors for febrile status epilepticus: a case-control study[J]. J Pediatr, 2013, 163(4): 1147-1151.
14. Tatro HA, Hamilton LA, Peters C, et al. Identification of risk factors for refractory status epilepticus[J]. Ann Pharmacother, 2020, 54(1): 14-21.
15. Tu TM, Loh NK, Tan NC. Clinical risk factors for non-convulsive status epilepticus during emergent electroencephalogram[J]. Seizure, 2013, 22(9): 794-797.
16. Beuchat I, Rosenow F, Kellinghaus C, et al. Refractory status epilepticus: risk factors and analysis of intubation in the multicenter SENSE registry[J]. Neurology, 2022, 99(16): e1824-e1834.
17. Freedman DA, Roach ES. Status epilepticus[J]. Pediatr Rev, 2023, 44(7): 383-392.
18. Rubinos C. Emergent management of status epilepticus[J]. Continuum (Minneap Minn), 2024, 30(3): 682-720.
19. Migdady I, Rosenthal ES, Cock HR. Management of status epilepticus: a narrative review[J]. Anaesthesia, 2022, 77(Suppl 1): 78–91.
20. 呂振, 黃華. 癲癇持續狀態相關并發癥的研究進展[J]. 癲癇與神經電生理學雜志, 2024, 33(06): 368-371.LV Zhen, HUANG Hua. Research progress on complications associated with status epilepticus[J]. Journal of Epilepsy and Neuroelectrophysiology, 2024, 33(06): 368-371.
21. Bleck TP. Refractory status epilepticus[J]. Curr Opin Crit Care, 2005, 11(2): 117-120.
22. Cuero MR, Varelas PN. Super-refractory status epilepticus[J]. Curr Neurol Neurosci Rep, 2015, 15(11): 74.
23. Tian Z, Xu Y, He R, et al. Clinical characteristics and risk factors for severity and prognosis of convulsive status epilepticus[J]. Brain Behav, 2025, 15(8): e70681.
24. Zhang L, Zheng W, Chen F, et al. Associated factors and prognostic implications of non-convulsive status epilepticus in ischemic stroke patients with impaired consciousness[J]. Front Neurol, 2021, 12: 795076.
25. Wang D, Li M, Pan Y, et al. Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study[J]. Ther Adv Neurol Disord, 2023, 16: 17562864231214846.
26. Betjemann JP, Lowenstein DH. Status epilepticus in adults[J]. Lancet Neurol, 2015, 14(6): 615-624.
27. Lawson T, Yeager S. Status epilepticus in adults: a review of diagnosis and treatment[J]. Crit Care Nurse, 2016, 36(2): 62-73.
28. Vossler DG. First seizures, acute repetitive seizures, and status epilepticus[J]. Continuum (Minneap Minn), 2025, 31(1): 95-124.
29. Trinka E, H?fler J, Zerbs A. Causes of status epilepticus[J]. Epilepsia, 2012, 53(Suppl 4): 127–138.
30. Brown I, Sheeran P, Reuber M. Enhancing antiepileptic drug adherence: a randomized controlled trial[J]. Epilepsy Behav, 2009, 16(4): 634-639.
31. Valton L, Benaiteau M, Denuelle M, et al. Etiological assessment of status epilepticus[J]. Rev Neurol (Paris), 2020, 176(6): 408-426.
32. 陳庭亮, 李衛. 重型顱腦損傷合并早期癲癇持續狀態的診斷與治療[J]. 中華神經醫學雜志, 2005, 56(5): 511-512.CHEN Tingliang, LI Wei. Diagnosis and treatment of severe traumatic brain injury combined with early status epilepticus[J]. Chinese Journal of Neuromedicine, 2005, 56(5): 511-512.
33. Singh G. Other central nervous system infections and status epilepticus[J]. Epilepsia, 2009, 50(Suppl 12): 67–69.
34. Misra UK, Kalita J, Nair PP. Status epilepticus in central nervous system infections: an experience from a developing country[J]. Am J Med, 2008, 121(7): 618-623.
35. Fung FW, Abend NS. EEG monitoring after convulsive status epilepticus[J]. J Clin Neurophysiol, 2020, 37(5): 406-410.
36. Meletti S, Monti G, Mirandola L, et al. Neuroimaging of status epilepticus[J]. Epilepsia, 2018, 59(Suppl 2): 113–119.
37. Chen D, Zhang Q, Miao H, et al. The impact of comorbidities, EEG abnormalities, and ASM use as a predicting outcomes in pediatric status epilepticus[J]. Neuropsychiatr Dis Treat, 2025, 21: 1689-1702.
38. Zimmern V, Korff C. Status epilepticus in children[J]. J Clin Neurophysiol, 2020, 37(5): 429-433.

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Risk factors for status epilepticus: a systematic review and meta-analysis

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