Status epilepticus in the elderly patients: A national data study in Thailand

Tiamkao, Somsak; Pranboon, Sineenard; Thepsuthammarat, Kaewjai; Sawanyawisuth, Kittisak

doi:10.1016/j.jns.2016.11.013

Cited by 14 publications

(18 citation statements)

References 34 publications

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“…The most common causes of epilepsy in older age groups are cerebrovascular, neurodegenerative, and neoplastic disease, whereas idiopathic epilepsy (presumed genetic) is the most common etiology in younger individuals . The incidence of status epilepticus in the elderly is almost twice that of younger individuals and is associated with higher mortality . Elderly individuals with epilepsy have an increased risk of medical and psychiatric comorbidities such as depression, osteoporosis, and cognitive decline …”

Section: Introductionmentioning

confidence: 99%

“…3 The incidence of status epilepticus in the elderly is almost twice that of younger individuals and is associated with higher mortality. 4,5 Elderly individuals with epilepsy have an increased risk of medical and psychiatric comorbidities such as depression, osteoporosis, 6 and cognitive decline. 7 Treating epilepsy in the elderly is complicated by various factors related to aging, including multiple medical comorbidities as well as changing pharmacokinetics and pharmacodynamics.…”

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confidence: 99%

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The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

et al. 2019

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Objective To evaluate the efficacy and tolerability of antiepileptic drugs (AEDs) in elderly individuals with epilepsy. Methods We searched four electronic databases as well as bibliographies and conference abstracts. Published and unpublished, randomized, or quasirandomized trials reporting the use of AEDs in people aged at least 60 years with epilepsy were eligible for inclusion. Two authors independently carried out each stage of the review. Meta‐analyses were performed using random‐effects models. Results Three thousand four hundred seventeen titles and abstracts were reviewed. Eighteen studies evaluating 12 AEDs met all eligibility criteria. Ten studies, comprising 1999 subjects, were suitable for meta‐analysis. Among the elderly with epilepsy, lamotrigine (LTG) is better tolerated relative to carbamazepine (pooled weighted risk ratio [RR] of experiencing withdrawal due to adverse events = 1.83, 95% confidence interval [CI] = 1.23‐2.43). There is a higher probability, although with a 95% CI of borderline importance, of seizure freedom when comparing levetiracetam to LTG (RR = 0.83, 95% CI = 0.68‐0.97). Single studies provide evidence for the efficacy and/or tolerability of other AEDs in the elderly, including brivaracetam, gabapentin, lacosamide, perampanel, and topiramate. The risk of bias of the included studies was frequently low or unclear, although there was on occasion a high risk of bias (especially with regard to selective reporting). Significance There is some evidence for AED use in the elderly with epilepsy. More evidence is required, comparing newer AEDs to prior generations as well as examining the effects of determinants such as frailty, to guide clinicians when treating this rapidly growing patient population.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

et al. 2019

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“…Advanced age has been reported to be the predictor for SE mortality in several studies including both those that use STESS and those that use EMSE predictive models. [21][22][23] Our subgroup analysis showed slightly different predictors in those younger than 18 years or over 60 years old (Table 4). 4 A study using the STESS model also showed that for each 1-year increase in age, risk of SE mortality increased by 1.03 times.…”

Section: Discussionmentioning

confidence: 77%

“…15,18 This study found that 5 SE complications (Table 3) were independently associated with SE mortality, as reported previously. [21][22][23] Our subgroup analysis showed slightly different predictors in those younger than 18 years or over 60 years old ( Table 4). All models were validated by another study population with good correlation and diagnostic properties ( Table 4).…”

Section: Discussionmentioning

confidence: 77%

Risk score predictive of mortality in status epilepticus according to a national database

et al. 2018

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Status epilepticus (SE) is a serious neurologic condition with high morbidity and mortality rates. This study aimed to develop and validate a risk score that is predictive of mortality in patients with SE using clinical factors without electrocardiography. The inclusion criteria of this study were all patients diagnosed with SE and treated between 2005 and 2015. We retrospectively searched for eligible patients using the International Classification of Diseases, Tenth Revision (ICD-10) code for SE (G41) in the national Universal Health Coverage database. The outcome was death at discharge or within 30 days after discharge. Factors-associated death was analyzed using stepwise logistic regression analysis. Risk scores were developed based on the final logistic regression model. The final model was also validated. There were 10 924 patients used for model development and 10 808 used for model validation. The formula to determine the risk score for SE mortality was 5 × shock + 4 × age over 60 years old + 3.5 × heart diseases + 3 × acute renal failure + 3 × septicemia + 2.5 × central nervous system infection + 2.5 × age 41-60 years old + 2 × cancer + 2 × chronic renal failure + 1.5 × age 21-40 years old + 1 × pneumonia + 1 × respiratory failure + 1 × anemia. The risk scores of greater than 4 indicated risk for mortality with a sensitivity of 78.20% and specificity of 75.38%. The area under the receiver-operating characteristic (ROC) curve for death in the final model was 83.59%. The area under the ROC curve for the model validation group was 83.52%. SE patients who had a risk score of 4 or more were at high risk for death. Physicians should be aware of the high mortality rate in these particular patients.

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“…The mortality rate of adult status epilepticus (SE) in Thailand is approximately 14.5-35%. Meanwhile, the mortality rate of RSE is around 42% [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Oral Micronized Progesterone That Converts to Allopregnanolone as an Adjunctive Treatment in Refractory Status Epilepticus: A Prospective Interventional Phase IIa Study

Sithinamsuwan¹,

Santimaleeworagun²,

Saelim³

et al. 2020

Preprint

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Background: We aimed to study the efficacy and safety of allopregnanolone which convert from oral micronized progesterone as an adjunctive treatment for Thai patients with refractory status epilepticus.Methods: Adults 18–80 years old who diagnosed with either convulsive or non-convulsive refractory status epilepticus receiving standard AED treatment, intravenous midazolam, for longer than 60 minutes were included. The intervention group received Utrogestran® (micronized progesterone, 200 mg/capsule) via enteric feeding every 8 h for five days. Treatments for RSE were continuing along the clinical trial period. Serum allopregnanolone levels were measured by radioimmunoassay (DetectX® Allopregnanolone Immunoassay Kit; Arbor Assays, Michigan, United States). Control patients were randomly selected from our hospital RSE cohort during 2015–2019. Continuous data were presented as the mean and standard deviation. Discrete data were assessed by number and percentage. The changes in laboratories were analyzed by paired t-test. The difference between groups were compared by independent sample t-test. The Mann-Whitney U test, Chi-square test or Fisher’s exact test were used for non-parametric parameters. A p-value < 0.05 indicated statistical significance. All analyses were performed using SPSS version 26 software (IBM Corp., Armonk, NY).Results: The average duration of refractory status epilepticus after treatment with midazolam plus progesterone (intervention group) and without progesterone until status epilepticus termination was 25.5 and 58.4 hours, (p = 0.004), indicated that allopregnanolone significantly shortens the refractory status epilepticus duration in vivo.Conclusions: Allopregnanolone, produced from oral micronized progesterone, demonstrates efficacy and safety in treating refractory status epilepticus as an adjunctive treatment.Trial registration: This trial was registered in Thai Clinical Trials Registry (TCTR) database. The trial registration number was “TCTR20200717002”, 16 July 2020, retrospectively registered.

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Status epilepticus in the elderly patients: A national data study in Thailand

Cited by 14 publications

References 34 publications

The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

The medical treatment of epilepsy in the elderly: A systematic review and meta‐analysis

Risk score predictive of mortality in status epilepticus according to a national database

Efficacy and Safety of Oral Micronized Progesterone That Converts to Allopregnanolone as an Adjunctive Treatment in Refractory Status Epilepticus: A Prospective Interventional Phase IIa Study

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