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Nonconvulsive status epilepticus in the elderly.

S Dupont1, K Kinugawa2

  • 1Epilepsy Unit, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Rehabilitation Unit, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; UMPC-UMR 7225 CNRS-UMRS 975 Inserm, centre de recherche, institut du cerveau et de la moëlle epinière (ICM), Paris, France; Université Paris Sorbonne, Paris, France.

Revue Neurologique
|March 15, 2020
PubMed
Summary
This summary is machine-generated.

Nonconvulsive status epilepticus (NCSE) is more common in older adults, often presenting subtly. Diagnosis requires EEG, and treatment involves antiepileptic drugs, with a poor prognosis and high mortality.

Keywords:
ConfusionEEGElderlyNonconvulsive status epilepticusStroke

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Area of Science:

  • Neurology
  • Geriatrics
  • Epileptology

Background:

  • Status epilepticus (SE) has a higher incidence in older adults.
  • Nonconvulsive status epilepticus (NCSE) is the predominant form in this demographic.
  • NCSE often presents with subtle or atypical symptoms, complicating diagnosis.

Purpose of the Study:

  • To describe the clinical presentation, risk factors, diagnostic challenges, treatment, and prognosis of NCSE in older adults.
  • To highlight the importance of electroencephalogram (EEG) in diagnosing NCSE in this population.
  • To provide guidance on the management and expected outcomes of NCSE in the elderly.

Main Methods:

  • Review of clinical presentations of NCSE in older adults.
  • Identification of risk factors associated with NCSE onset.
  • Emphasis on the diagnostic role of continuous EEG monitoring and Salzburg EEG criteria.
  • Description of treatment strategies, including benzodiazepines and antiepileptic drugs.
  • Analysis of prognostic factors and mortality rates.

Main Results:

  • NCSE commonly presents as prolonged focal seizures with impaired consciousness, confusional states, or subtle neurological signs.
  • Risk factors include prior generalized tonic-clonic seizures, epilepsy history, female gender, and brain injury (e.g., stroke).
  • Diagnosis is challenging due to non-specific symptoms and necessitates unrestricted EEG use.
  • Treatment involves benzodiazepines followed by antiepileptic drugs; intubation is generally avoided.
  • NCSE in older adults is associated with a poor prognosis, with approximately 30% mortality.

Conclusions:

  • NCSE is a significant neurological emergency in older adults, often presenting atypically.
  • Early and accurate diagnosis via EEG is crucial for timely and effective management.
  • Despite treatment, NCSE in this population carries a substantial risk of mortality and morbidity.