Status epilepticus in the elderly—A retrospective study on 120 patients

Rohracher, Alexandra; Reiter, Doris P.; Brigo, Francesco; Kalss, Gudrun; Thomschewski, Aljoscha; Novak, Helmut F.; Zerbs, Alexander; Dobesberger, Judith; Akhundova, Aynur; Höfler, Julia; Kuchukhidze, Giorgi; Leitinger, Markus; Trinka, Eugen

doi:10.1016/j.eplepsyres.2016.08.016

Cited by 53 publications

(80 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Second, it was conducted in a single third‐level center; a selection bias may be present, although this seems unlikely because SE is habitually treated in large hospitals. We believe therefore that our results are generalizable, as the overall mortality and patient profile appear to be in line with other hospital‐based series . Third, we did not assess treatment adequacy in respect to current guidelines, as this does not seem to influence outcome .…”

Section: Discussionsupporting

confidence: 58%

“…We believe therefore that our results are generalizable, as the overall mortality and patient profile appear to be in line with other hospital-based series. 7,18 Third, we did not assess treatment adequacy in respect to current guidelines, as this does not seem to influence outcome. 15 Fourth, functional outcome was evaluated at discharge, at irregular time points across patients; an information bias might be present because neurological condition may change overtime.…”

Section: E99mentioning

confidence: 99%

See 1 more Smart Citation

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

2018

View full text Add to dashboard Cite

It is unclear whether the outcome of status epilepticus (SE), a neurological emergency associated with high mortality and morbidity, has changed over the past decade. We investigated the difference in prognosis (mortality, functional status at discharge) after adult SE episodes in a large registry between 2 time points (the years 2009 and 2017), exploring factors potentially associated with outcome, with particular attention to use of newer antiepileptic drugs (AEDs). Newer AEDs were more often prescribed in SE episodes in 2017 (80.2% vs 38.5%, P < .001); this independently correlated with year of observation, SE refractoriness, nonconvulsive SE forms, and number of AEDs. We observed a higher proportion of deterioration from baseline conditions in 2017 (67.7% vs 42.3%, P < .001), which was independently associated with, among other variables, use of newer AEDs (odds ratio = 2.91, 95% confidence interval = 1.13-7.48), whereas mortality seemed more stable over time (16.1% vs 6.3%, P = .08) without any relationship with newer AEDs. These observations suggest that newer AEDs might affect functional status but not mortality. Further investigations are necessary to improve therapeutic strategies, which currently rely on weak evidence.

show abstract

Section: Discussionsupporting

confidence: 58%

Section: E99mentioning

confidence: 99%

Use of newer antiepileptic drugs and prognosis in adults with status epilepticus: Comparison between 2009 and 2017

2018

View full text Add to dashboard Cite

show abstract

“…10,11 Our study shows that elderly patients with epilepsy usually respond well to AED treatment because more than 70% of patients achieved seizure freedom in both the new-onset and persistent epilepsy groups. It is also possible that there is frequent deviation from the guideline treatment in these patients regarding dose, administration rate, and sequence of AEDs.…”

Section: Discussionmentioning

confidence: 81%

“…It is also possible that there is frequent deviation from the guideline treatment in these patients regarding dose, administration rate, and sequence of AEDs. 10,11 Our study shows that elderly patients with epilepsy usually respond well to AED treatment because more than 70% of patients achieved seizure freedom in both the new-onset and persistent epilepsy groups. Patients in both groups were administered nearly two AEDs on average, but total AED loads measured by PPD/DDD were lower than one in both groups, so the high number of AEDs must have resulted from the combined use of lower-dosage drugs to avoid the adverse effects of individual drugs.…”

Section: Discussionmentioning

confidence: 81%

Comparison of new-onset and persistent epilepsy in the elderly

Kim

2019

Acta Neurol Scand

View full text Add to dashboard Cite

Epidemiological studies show that the incidence of epilepsy is significantly higher in the elderly than in any other age groups, and the prevalence of epilepsy increases rapidly with age except in the very young population. 1 The high prevalence of epilepsy in the elderly may result from the more frequent epilepsy-associated neurological diseases such as stroke and traumatic brain injury, 2 but the improved survival of previously diagnosed epilepsy patients can affect the high prevalence in the elderly population because life expectancy did not decrease significantly in adult epilepsy patients with improvements in general medical care. 3 Although there have been a number of studies on elderly patients with epilepsy, most studies included only patients with new-onset disease and excluded patients who began to suffer from epilepsy before the age of 65 and aged. 4,5 Only several studies compared clinical features of epilepsy in the elderly between the earlier and later onset groups with psychosocial considerations. 7,8 We hypothesized that elderly patients with persistent epilepsy may have different clinical features than those with new-onset disease, and we compared the characteristics of new-onset and persistent epilepsy in the elderly in various aspects, including the results of diagnostic evaluations, comorbidity, treatment, and prognosis. AbstractBackground: Previous studies on elderly epilepsy included only patients with newonset disease, but there are many patients who developed epilepsy earlier and aged. Aim:We compared the characteristics of new-onset and persistent epilepsy in the elderly. Methods:We performed a 10-year retrospective analysis of elderly patients with epilepsy divided into two groups according to the onset of seizure: new-onset epilepsy (onset age ≥65) and persistent epilepsy (onset age<65). Results: Nearly half (78/172, 45.3%) of patients in the new-onset group presented as status epilepticus, and one-fourth of these (19/78, 24.4%) died during the initial treatment for status epilepticus. Patients in the new-onset epilepsy group presented more frequently as status epilepticus (59/153 vs 12/78, P < 0.001) and had a past history of status epilepticus (63/153 vs 20/78, P = 0.02). History of stroke (81/153 vs 30/78, P = 0.04), hypertension (83/153 vs 29/78, P = 0.01), and dyslipidemia (53/153 vs 17/78, P = 0.05) was more common in the new-onset group, but patients in the persistent group used more antiepileptic drugs (AEDs; P = 0.036) and total AED drug loads (P = 0.028). Conclusions:Our study shows that new-onset epilepsy has a higher incidence of status epilepticus and more stroke-related risk factors but may require fewer AEDs for epilepsy control. K E Y W O R D Selderly, epilepsy, status epilepticus in the new-onset group. Similar results were also observed in one previous study, 7 and differences in underlying pathological changes between the two groups could have affected this finding. 13 Patients in the new-onset epilepsy group had higher chances of stroke, hypertension, and dyslipidemi...

show abstract

“…Additionally, the mortality rates tended to be higher in age group of N 80 years in almost all years (Table 4). Advanced age is one factor associated with mortality other than disability status [33].…”

Section: Discussionmentioning

confidence: 99%