Prognosis of status epilepticus in elderly patients.

ABSTRACT

PURPOSE: To evaluate the clinical features and prognosis of status epilepticus (SE) in patients above 70 years old. METHODS: Retrospective analysis of all patients ≥70 years old with SE registered prospectively during 4 years. Follow-up after discharge was performed. RESULTS: Ninety patients were evaluated. Acute symptomatic etiology was the most prevalent. The mean number of antiepileptic drugs (AEDs) used was 2.7 ± 1.2, and 21% of the patients required sedation. A poor outcome was considered when death (31.1%) or developing of new neurological impairment at discharge (32.2%) occurred. After multivariate analysis, four variables predicted a poor outcome: acute symptomatic etiology (OR 6.320; 95% CI 1.976-20.217; P = .002), focal motor SE type (OR 9.089; 95% CI 2.482-33.283; P = .001), level of consciousness (OR 4.596; 95% CI 1.903-11.098; P = .001), and SE duration >12 hours (OR 3.763; 95% CI 1.130-12.530; P = .031). Independent predictive factors of mortality were SE duration >12 hours (OR 4.306; 95% CI 1.044-17.757; P = .043), modified Status Epilepticus Severity Score (mSTESS) (OR 2.216; 95% CI 1.313-3.740; P = .003), and development of complications (OR 3.334; 95% CI 1.004-11.070, P = .049). Considering long-term mortality, age (HR 1.036; 95% CI 1.001-1.071; P = .044), a potentially fatal underlying cause (HR 2.609; 95% CI 1.497- 4.548; P = .001), and mSTESS score >4 (HR 1.485; 95% CI 1.158-1.903; P = .002) remained as predictive factors. There was no association between sedation and the number of AEDs used with outcome at discharge or long-term mortality (P > .05). CONCLUSIONS: SE above 70 years old has a high morbimortality. Prognosis is not related to treatment aggressiveness.