Aetiology and outcome of generalized convulsive status epilepticus in elderly

Jayalakshmi, Sita; Vooturi, Sudhindra; Chepuru, Ramesh; Sahu, Sambit; Mohandas, Sukhada

doi:10.1016/j.seizure.2015.03.011

Cited by 13 publications

(16 citation statements)

References 27 publications

(24 reference statements)

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“…Yoshimura et al reported that poor outcome was associated with acute symptomatic (p = 0.003) and remote symptomatic (p = 0.02) compared with cryptogenic SE [22]. In our study, only acute symptomatic SE was associated with poor outcome, which is in concordance with few reports [4,24]. Treiman et al reported that the 30-day mortality was 27% and unresponsiveness to the first AED was the most significant risk factor [13].…”

Section: Discussionsupporting

confidence: 91%

Comparing the efficacy of sodium valproate and levetiracetam following initial lorazepam in elderly patients with generalized convulsive status epilepticus (GCSE): A prospective randomized controlled pilot study

Nene¹,

Mundlamuri²,

Satishchandra³

et al. 2019

Seizure

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This randomized control study was conducted to compare the efficacy of sodium valproate (SVP) and levetiracetam (LEV) following initial intravenous lorazepam in elderly patients (age: > 60years) with generalized convulsive status epilepticus (GCSE) and to identify predictors of poor seizure control.Methods: A total of 118 patients (mean age: 67.5 ± 7.5 years, M:F = 1.6:1), who had presented with GCSE were randomized into the SVP or LEV treatment arms. All patients received initial intravenous lorazepam (0.1 mg/kg) followed by one of the two antiepileptic drugs (AEDs), parenteral SVP (20-25 mg/kg) or LEV (20-25 mg/kg). Those who failed to achieve control with the initial AED, were crossed over to receive the other AED. One-hundred patients (SVP = 50; LEV = 50) completed the study.Results: SE could be controlled with lorazepam and one of the AEDs (SVP or LEV) in 71.18% (84/118). Intention-to-treat analysis showed that the two groups did not differ significantly in terms of seizure control [SVP: 41/60 (68.3%); LEV: 43/58 (74.1%), p = 0.486]. Of 100 patients who completed the study, seizure control was achieved in 38/50(76%) in the SVP and 43/50(86%) in the LEV group (p = 0.202). After crossing over to the second AED, SE could be controlled in an additional in 50% (6/12) in SVP (+LEV) group and in 14.3% (1/7) in LEV (+SVP) group. Overall, after the second AED, seizure control was achieved in 77.1% (91/ 118). Higher STESS was associated with poor therapeutic response (p = 0.049).Conclusions: The efficacy of SVP and LEV following initial lorazepam in controlling GCSE in elderly population was comparable, hence the choice of AED could be individualized.

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Section: Discussionsupporting

confidence: 91%

Comparing the efficacy of sodium valproate and levetiracetam following initial lorazepam in elderly patients with generalized convulsive status epilepticus (GCSE): A prospective randomized controlled pilot study

Nene¹,

Mundlamuri²,

Satishchandra³

et al. 2019

Seizure

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“…Whereas the mortality rate is about 13% in young adults, it reaches 38% in older adults of 60–79 years old, and was found up to 50% after 80 years [ 17 ]. Regarding severity of status epilepticus, mortality has been demonstrated as higher in patients with refractory status epilepticus [ 18 ] or super refractory status epilepticus aged over 75 years [ 19 ]. Independent predictors of mortality are also particularly marked by age since 65 years old has been identified as a fatal cut off value in several studies [ 17 , 18 , 20 , 21 , 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding severity of status epilepticus, mortality has been demonstrated as higher in patients with refractory status epilepticus [ 18 ] or super refractory status epilepticus aged over 75 years [ 19 ]. Independent predictors of mortality are also particularly marked by age since 65 years old has been identified as a fatal cut off value in several studies [ 17 , 18 , 20 , 21 , 22 , 23 ]. Others factors associated with hospital mortality are related to seizure duration, an underlying CNS structural lesion, de novo status epilepticus, intensity of consciousness disorders at scene and refractory status epilepticus [ 20 , 21 , 22 , 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Managing Status Epilepticus in the Older Adult

Legriel

Brophy

2016

JCM

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The aim of this systematic review was to describe particularities in epidemiology, outcome, and management modalities in the older adult population with status epilepticus. There is a higher incidence of status epilepticus in the older adult population, and it commonly has a nonconvulsive presentation. Diagnosis in this population may be difficult and requires an unrestricted use of EEG. Short and long term associated-mortality are high, and age over 60 years is an independent factor associated with poor outcome. Stroke (acute or remote symptomatic), miscellaneous metabolic causes, dementia, infections hypoxemia, and brain injury are among the main causes of status epilepticus occurrence in this age category. The use of anticonvulsive agents can be problematic as well. Thus, it is important to take into account the specific aspects related to the pharmacokinetic and pharmacodynamic changes in older critically-ill adults. Beyond these precautions, the management may be identical to that of the younger adult, including prompt initiation of symptomatic and anticonvulsant therapies, and a broad and thorough etiological investigation. Such management strategies may improve the vital and functional prognosis of these patients, while maintaining a high overall quality of care.

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“…Higher mortality in older adults also contrasts to the less than 5% mortality among younger adults well into the fourth decade of life [11,16]. Previously, among older adults, the overall mortality rates with SE in hospital-based studies have ranged from 6.5% to 31% [5,6,7,8,9,10,11]. However, in contrast to our study in older adults, these prior investigations among older adults were limited by being single center studies, primarily done outside the United States, and with very small sample sizes (range of 33 to 140 subjects) [5,6,7,8,9,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…Epidemiological studies indicate that older adults have an increased propensity for SE and associated higher mortality [3,4]. However, hospital-based studies in older adults are limited by their small sample size from single institutional studies [5,6,7,8,9,10,11]. Others included an all adult population [12] or were focused on specific subgroup etiologies [13].…”

Section: Introductionmentioning

confidence: 99%

Status Epilepticus among Older Adults in the United States

Mendiratta

Dayama²,

Wei

et al. 2019

Geriatrics

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Objective: This study aimed to identify temporal time trends and risk factors associated with mortality for hospitalized older adults with status epilepticus (SE). Design: A retrospective study was performed. Setting: Hospitalized patients were identified utilizing an administrative database—The Nationwide Inpatient Sample database from 1998 through September 2015. Patients: Patients were older adults 65 years and older with SE. Interventions: No interventions were undertaken. Measurements and Main Results: Demographic, temporal trends, clinical characteristics, and outcome data were abstracted. The results indicated that hospitalized elderly Americans with SE increased over the 11-year study period. Univariate and multivariate analyses were performed to evaluate risk factors associated with mortality in the study cohort. From the weighted sample, 130,109 subjects were included. Overall mortality was 19%. For age subgroups, the mortality was highest for the >85 years age group (24.1%) compared to the 65–75 years (19%) and 75–85 years (23%) age groups. Among investigated etiologies, the three most common causes of SE were acute ischemic stroke (11.2% of total) followed by non-traumatic brain hemorrhage (5.4%) and malignant brain lesions (4.9%). The highest mortality by etiology was noted for acute traumatic brain injury (TBI) (31.5%), non-traumatic brain hemorrhage (31%), and acute ischemic stroke (AIS) (30.1%). Multivariate analysis indicated that non-survivors when compared to survivors were more like to have the following characteristics: older age group, acute TBI, brain neoplasms, non-traumatic brain hemorrhage, AIS and central nervous system (CNS) infections, and utilization of mechanical ventilation. Associated conditions significantly increasing risk of mortality were sodium imbalance, cardiac arrest, anoxic brain injury, pneumonia, and sepsis. Comorbidities associated with increased risk of mortality included valvular heart disease, renal failure, liver disease, and neoplasms. Conclusions: The number of hospitalized elderly Americans with SE increased over the 11-year study period. Overall mortality was 19%, with even higher mortality among various patient subsets. Several demographic and co-morbid factors are associated with increased mortality in this age group.

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Aetiology and outcome of generalized convulsive status epilepticus in elderly

Abstract: Less than one-third of elderly patients with CSE progressed to RSE. Vascular aetiology, the leading cause of generalized CSE in elderly, was not associated with progression to RSE and mortality. Acute symptomatic aetiology was associated with high mortality.

Cited by 13 publications

References 27 publications

Comparing the efficacy of sodium valproate and levetiracetam following initial lorazepam in elderly patients with generalized convulsive status epilepticus (GCSE): A prospective randomized controlled pilot study

Comparing the efficacy of sodium valproate and levetiracetam following initial lorazepam in elderly patients with generalized convulsive status epilepticus (GCSE): A prospective randomized controlled pilot study

Managing Status Epilepticus in the Older Adult

Status Epilepticus among Older Adults in the United States

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