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We read with interest the study by Cavaliere et al.1 We are particularly intrigued by their report of a 30-day mortality rate of 50% in patients with systemic cancer and brain metastases presenting in convulsive status epilepticus (CSE). We have recently reported a series of 4 patients with systemic cancer presenting in de novo nonconvulsive status epilepticus (NCSE) who were diagnosed with metastatic CNS disease via brain imaging at the time of presentation.2 All patients demonstrated improvement in mental status after treatment with anticonvulsants; however, 2 patients died at 5 and 20 days, respectively, after the onset of NCSE. Although the number of patients in our series was small, the 30-day mortality of 50% in patients with NCSE is the same as in the series by Cavaliere et al of 10 patients with systemic cancer and CSE.
Nonconvulsive status epilepticus is a more challenging diagnosis than CSE because its clinical features include an absence of convulsive activity in the presence of altered mental status,3 - 4 which in itself carries a long list of differential diagnoses in a cancer patient. Nonconvulsive status epilepticus is associated with 18% mortality in noncancer patients,5 but the mortality rate in cancer patients is unknown. The findings of the study by Cavaliere at al1 and our published report2 suggest that mortality in patients with systemic cancer and CNS metastases presenting in either CSE or NCSE is higher than in noncancer patients or those with primary brain tumors. We conclude that both CSE and NCSE in patients with systemic cancer warrant a prompt diagnosis and investigation for CNS metastases with brain imaging because both types of status epilepticus appear to be associated with the development of new or progressive metastatic brain lesions.1 - 2 Treatment with anticonvulsants is indicated, although it remains unknown whether it can impact the outcome and improve survival.
Correspondence: Dr Blitshteyn, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (blitshteyn.svetlana@mayo.edu).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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