Risk and prognostic factors of status epilepticus in the elderly: A case-control study

Abstract

consecutive patients aged 70 years or older with SE were included. Each patient was matched to three controls without SE seen during the same period. Matching variables were age (±3 years), gender, and comorbidity index (±3). Multivariate logistic regression model were used to compare cases to controls and, among the cases, nonsurvivors to survivors. Key Findings: By multivariate analysis, factors independently associated with SE were acute decompensation (cardiac, respiratory, or hepatic) [adjusted odds ratio (OR a ) 2.57, 95% confidence interval (95% CI) 1.05-6.25] history of epilepsy (OR a 3.93, 95% CI 1.27-12.14), chronic cerebrovascular disease (OR a 7.96, 95% CI 3.31-19.15), nonvascular dementia (OR a 4.16, 95% CI 1.86-9.29), and dysnatremia (OR a 5.08, 95% CI 2.34-11.04). In-hospital 1-month mortality was 2.3 times higher among cases than controls (14/63, 22.0%; 95% CI 12.7-34.5%; vs. 18/189, 9.5%; 95% CI 5.7-14.7%; p = 0.01). Among the cases, factors independently associated with in-hospital death within 1 month were younger age (OR a per 1-year increase 0.87, 95% CI 0.76-0.98), higher comorbidity index (OR a per 1-point increase 1.27, 95% CI 1.07-1.55), and de novo SE (OR a 14.95, 95% CI 2. 24-192.8). Significance: Independent predictors of SE in hospitalized patients aged 70 years or older were acute decompensation (cardiac, respiratory, or hepatic), history of epilepsy, chronic cerebrovascular disease, nonvascular dementia, and dysnatremia. Factors that independently predicted death in patients with SE were younger age, higher comorbidity index, and de novo SE.

Status Epilepticus: Epidemiology and Public Health Needs

“…In the Asian continent, a not-so-different demographic profile is found, with a fairly equal sex distribution with 53%–57% males, a male-to-female ratio of 1.35:1 and an incidence of the first SE episode of 42/100,000/year [14,15,16]. Meanwhile, countries like Italy, France and Switzerland have an inverse male-to-female ratio [17,18,19,20]. According to the study by Chin et al, the incidence of SE in children 15 or younger in the U.K. is 14.5/100,000/year, being the highest for those aged one year or less with an incidence of 51/100,000/year [21].…”

“…7.9 95% C.I. 3.3–19.15), along with trauma, acute cardiac, respiratory or hepatic decompensation, epilepsy and dysnatremia were factors significantly associated with SE [19]. In a recent study of a large administrative database, Urtecho et al found that risk factors for SE in patients with severe sepsis and septic shock were younger age, female gender, black race, the presence of metabolic derangements and renal and respiratory dysfunction.…”

Extended EEG and non-convulsive status epilepticus: Benefit over routine EEG?

“…20,21 The cohort of the present analysis has its own specificity, as it includes mostly refractory, non-convulsive SE without coma in elderly patients, a population being at higher risk of intensive care complications, 22,23 and therefore less often managed in intensive care units. 20,21 The cohort of the present analysis has its own specificity, as it includes mostly refractory, non-convulsive SE without coma in elderly patients, a population being at higher risk of intensive care complications, 22,23 and therefore less often managed in intensive care units.…”

“…This finding is reminiscent of the setting of post-anoxic coma, where patients managed with continuous EEG do not have better prognosis as compared to those receiving only routine recordings. 20,21 The cohort of the present analysis has its own specificity, as it includes mostly refractory, non-convulsive SE without coma in elderly patients, a population being at higher risk of intensive care complications, 22,23 and therefore less often managed in intensive care units. The two groups had the same characteristics in terms of SE severity (STESS score) and proportion of underlying severe causes.…”

Prognostic factors of status epilepticus in adults

“…No significant difference could be proven for the subgroups, refractory NCSE or refractory CSE, however, de novo seizures were associated with a trend towards a poorer prognosis. Previous studies have shown this correlation for SE in general, whereas the findings for refractory SE have been inconsistent (Drislane et al ., ; Novy et al ., ; Canoui‐Poitrine et al ., ; Hocker et al ., ). A possible explanation is that refractoriness by itself is a marker of a severe event, and that the damage caused by the SE overshadows the prognostic value of a de novo situation.…”