Observational studyEpilepsia2025
Prognostic factors and impact of management strategies for status epilepticus: The STEPPER study in the Emilia-Romagna region, Italy.
Observational study in Epilepsia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Improving emergency management of status epilepticus: a randomized high-fidelity simulator-based trial.Journal of neurology · 2026Trial
- Chronological Sequence of Convulsive Status Epilepticus Treatment Steps in a Real-Life Scenario for Patients Enrolled in a Large Multicenter Trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Trial
- Distinct clinical clusters of paediatric patients with status epilepticus: Retrospective cohort study.Developmental medicine and child neurology · 2026Article
- Emergency treatment delay and underdosing are associated with poor outcome in non-convulsive status epilepticus.Epilepsia · 2026Article
- Treatment adequacy outweighs treatment sequence in non-convulsive status epilepticus.Epilepsia · 2026Article
- Implementation Science Symposium: Moving the Needle in Epilepsy Care.Epilepsy currents · 2026Article
- Observational
- Seizure Clusters: Current Concepts in Definition and Treatment.Journal of clinical medicine · 2026Review
- Guidelines adherence in status epilepticus first steps treatment: factors associated with non-compliance and effect on outcome.Journal of neurology · 2025Article
- Prognostic factors and impact of management strategies for status epilepticus: The STEPPER study in the Emilia-Romagna region, Italy.Epilepsia · 2025Observational
- Treating status epilepticus in clinical practice-a multi-national survey in Germany, Austria, and Switzerland.Frontiers in neurology · 2025Article
- Benzodiazepines versus non-benzodiazepine antiseizure medications as first-line agents for status epilepticus: analysis of real word data from a 9-years prospective cohort.Frontiers in neurology · 2025Article
- Status epilepticus: the score question.Frontiers in neurology · 2025Review
- Anesthetics in status epilepticus: does one size fits it all?-A scoping review on titration goals, timing, and patient selection.Frontiers in neurologyReview
Corrections and comments
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Authors and funding
37 authors.
Funding
Abstract
objectiveThe STEPPER (Status Epilepticus in Emilia-Romagna) study aimed to investigate the clinical characteristics, prognostic factors, and treatment approaches of status epilepticus (SE) in adults of the Emilia-Romagna region (ERR), Northern Italy.
methodsSTEPPER, an observational, prospective, multicentric cohort study, was conducted across neurology units, emergency departments, and intensive care units of the ERR over 24 months (October 2019-October 2021), encompassing incident cases of SE. Patients were followed up for 30 days.
resultsA total of 578 cases were recruited (56% female, mean age = 70 years, 32% with previous diagnosis of epilepsy, 43% with in-hospital onset, 35% stuporous/comatose, 46% with nonconvulsive SE). Etiology was known in 87% (acute 43%, remote 24%, progressive 17%, definite epileptic syndrome 3%). The mean pre-SE Rankin Scale score was 2, the Status Epilepticus Severity Score was ≥4 in 33%, the Epidemiology-Based Mortality Score in Status Epilepticus score was ≥64 in 61%, and 34% were refractory. The sequence of treatments followed current clinical practice guidelines in 63%. Benzodiazepines (BDZs) were underused as first-line therapy (71%), especially in in-hospital onset cases; 15% were treated with continuous intravenous anesthetic drugs. Mortality was 24%; 63% of survivors had functional worsening. At the two-step multivariable analysis, incorrect versus correct treatment sequence with correct BDZ dose was the strongest predictor of failure to resolve SE in the in-hospital group (odds ratio [OR] = 4.42, 95% confidence interval [CI] = 1.86-10.5), with a similar trend in the out-of-hospital group (OR = 2.22, 95% CI = .98-5.02). In turn, failure to resolve was the strongest predictor of 30-day mortality (OR = 11.3, 95% CI = 4.16-30.9, out-of-hospital SE; OR = 6.42, 95% CI = 2.79-14.8, in-hospital SE) and functional worsening (OR = 5.83, 95% CI = 2.05-16.6, out-of-hospital SE; OR = 9.30, 95% CI 2.22-32.3, in-hospital SE). SIGNIFICANCE: The STEPPER study offers insights into real-world SE management, highlighting its significant morbidity and functional decline implications. Although nonmodifiable clinical factors contribute to SE severity, modifiable factors such as optimized first-line therapies and adherence to guidelines can potentially influence prognosis.
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