Status epilepticus in the elderly-A retrospective study on 120 patients.
Status epilepticus (SE) is one of the most common neurological emergencies with a high incidence in the elderly. Major determinants of prognosis are patients' age, duration of SE and underlying etiology. We aimed identifying differences in clinical presentation of SE, etiologies and outcome between patients (pts.) sixty years or older (≥60) and younger than sixty (<60) years (yrs).



We retrospectively analyzed 120 patients (48 women) with SE admitted to the Neurological Intensive Care Unit (NICU), Department of Neurology, Paracelsus Medical University Salzburg, Austria between 1/2011 and 01/2013.



Median age was 69 years (range 14-90) (63% ≥60yrs). Generalized tonic clonic SE was the most common SE type, whereas non convulsive SE with and without coma tended to occur more frequently in the elderly (33% ≥60 yrs. vs. 20%<60 yrs, Chi2=3.511, p=0.061). Preexisting history of epilepsy was more common in the younger age group (64% vs 41% p=0.014). An acute symptomatic cause of SE was identified in 25% (31/120), with cerebrovascular diseases being more frequent in the elderly (47% vs. 11%; p<0.01). Duration of SE did not differ between the age groups (p=0.63). Mortality was higher in elderly patients (31% vs. 7%, p=0.028, Chi Square=5.18) and moderate disability in younger patients (42% vs 17%; p=0.005, Chi Square=7.83). After Bonferroni correction only the higher rate of cerebrovascular etiologies in the elderly was statistically significant.



In the elder population, SE occurs more often in patients without preexisting epilepsy and is most frequently caused by cerebrovascular diseases. NCSE tends to be more frequent in the elderly and diagnosis is complicated by subtle clinical presentation. Even though comorbidities represent treatment limitations, in our sample no differences in choice of AED as well as dosage were observed between the age groups, reflecting a trend toward AEDs with more favorable adverse event profile in all patients. SE in older patients is associated with poorer outcome and higher mortality.
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Alexandra
A
Rohracher
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Doris P
DP
Reiter
Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy.
Francesco
F
Brigo
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Gudrun
G
Kalss
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Aljoscha
A
Thomschewski
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Helmut
H
Novak
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Alexander
A
Zerbs
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Judith
J
Dobesberger
Department of Neurology, Medical University Azerbaijan, Baku, Azerbaijan.
Aynur
A
Akhundova
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Julia
J
Höfler
Department of Neurology, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Giorgi
G
Kuchukhidze
Department of Neurology, Paracelsus Medical University, Salzburg, Austria.
Markus
M
Leitinger
Department of Neurology, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria. Electronic address: e.trinka@salk.at.
Eugen
E
Trinka
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants; D015897:Comorbidity; D003422:Critical Care; D004827:Epilepsy / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
D000927:Anticonvulsants
Elderly; Outcome; Status epilepticus