Focal nonconvulsive status epilepticus with impaired consciousness in older adults: Prognosis-related variables

To assess the prognosis-related clinical-EEG characteristics in older adults with focal nonconvulsive status epilepticus with impaired consciousness (focal NCSE).

We prospectively assessed clinical variables and EEG data at diagnosis and after an initial pharmacological protocol (within 24 hours) and their relationship with prognosis in older adults with focal NCSE treated at the emergency room.

The clinical presentation of focal NCSE in 45 adults (mean age 73.5 ± 9.1 years) was characterized by decreased consciousness and the presence of subtle ictal phenomena in 24 cases. On the initial EEG, there were lateralized periodic discharges (LPDs) and lateralized rhythmic delta activity (RDA) in 25 cases and epileptiform discharges (EDs > 2.5 Hz) in 32 cases. After the drug protocol, 33 (73.3%) cases had effective clinical improvement. Death after 30 days occurred in 10 (22.2%) cases. In simple and multiple logistic regression, it was observed that older adults with a history of epilepsy/seizures have a greater chance of clinical improvement. The occurrence of death was associated with the presence of RDA in the initial EEG and its subsequent disappearance (OR 6.93, 95% CI 1.20-46.01, p = 0.033). Higher mortality was associated with the presence of LPDs in the initial EEG and with the presence of LPDs/EDs > 2.5 Hz in the EEG after treatment.

The presence of ED > 2.5 Hz in the initial EEG was the most frequent pattern at focal NCSE. Clinical improvement was associated with a history of epilepsy/seizures. Mortality in the focal NCSE was high and was associated with the presence of RDA in the initial EEG and the occurrence of LPDs/ED > 2.5 Hz after treatment.