title: New-onset status epilepticus and cluster seizures in the elderly.
abstract: We evaluated the frequency, therapeutic response and predictors of status epilepticus (SE) and cluster seizures among elderly people. Patients over 60 years old with epilepsy (n=201; age, 68.0 ± 7.5 years) were prospectively recruited. Among them, 64 patients (32%) who presented with new-onset cluster attacks and/or SE formed the study group. All underwent evaluation with electroencephalography (EEG) and CT scans. The mean duration of SE and cluster seizures at admission was 14.9 ± 53.7 hours. Cluster seizures were observed in 53 (26.4%) and SE in 34 (17%) elderly patients with seizures (n=201). The types of SE were: generalized convulsive (23 patients), epilepsia partialis continua (eight patients), non-convulsive (two patients) and myoclonic (one patient). The types of epilepsy syndrome included were: acute symptomatic (37 patients; 57.8%), cryptogenic (15 patients; 23.4%) and remote symptomatic (12 patients; 18.8%). Interictal EEG was abnormal in 79.7% of patients with critical presentation compared to 53.3% of patients without critical presentation. Epileptiform activity was observed in 46.9% of patients with SE and/or cluster seizures compared to 27.0% without SE and/or cluster seizures (p=0.001). The neuroimaging differences between the two groups were the absence of white-matter changes on CT scan in those with, compared to those without, SE and/or cluster seizures (28.1% compared to 41.6%, p=0.06). The risk factors for SE and/or cluster seizures were: acute symptomatic seizures, simple partial seizures, a higher number of seizures, lower Glasgow coma scale (GCS) score and an absence of white-matter changes on CT scan. After multivariate analysis, lower GCS score (p=0.01; odds ratio [OR]=0.82) and a higher number of seizures (p=0.03; OR=1.03) significantly predicted the occurrence of SE and/or cluster seizures. Seizures were controlled with two antiepileptic drugs in 70.6%. To conclude, SE and/or cluster seizures are common (32%) among elderly patients with epilepsy. Early and aggressive treatment is effective in the majority.
authors: Department of Biostatistics, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore 560029, India.
authors: S
authors: S
authors: Sinha
authors: P
authors: P
authors: Satishchandra
authors: B R
authors: BR
authors: Kalband
authors: K
authors: K
authors: Thennarasu
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D013226:Status Epilepticus / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy
chemical_list: D000927:Anticonvulsants