Myoclonic status epilepticus in the elderly

Area of Science:

• Neurology
• Geriatrics
• Epileptology

Background:

• Myoclonic status epilepticus (MSE) is a critical neurological condition in elderly patients, characterized by near-continuous myoclonus and epileptiform EEG abnormalities.
• Understanding the features, etiologies, and prognoses of MSE in this population is crucial due to its clinical significance and potential for poor outcomes.

Purpose of the Study:

• To describe the ictal semiology, polygraphic findings, etiology, and prognosis of elderly patients diagnosed with MSE.
• To evaluate the correlation between etiology and prognosis in elderly MSE patients.
• To assess the relationship between MSE duration and clinical outcomes in this demographic.

Main Methods:

• A retrospective study was conducted on patients over 60 years old diagnosed with MSE between 2013 and August 2024.
• Clinical and electroencephalographic variables were analyzed.
• Statistical analysis was performed to assess correlations between etiology, MSE duration, and prognosis.

Main Results:

• Twenty-seven elderly patients (mean age 77.6 years) with MSE were analyzed, predominantly exhibiting proximal myoclonus in upper limbs and face.
• Etiologies included hypoxic-ischemic encephalopathy (HIE) in 9 cases, toxic-metabolic/infectious causes in 15, and neurodegenerative processes in 3.
• Prolonged MSE (>72h) correlated with ICU admission and mortality (9 deaths), while toxic-metabolic MSE showed a favorable prognosis, unlike refractory HIE-associated MSE.

Conclusions:

• Two distinct patterns of MSE in the elderly were identified: toxic-metabolic MSE with a favorable prognosis and HIE-associated MSE with high mortality.
• Early etiological identification is critical for guiding treatment strategies and defining prognosis in elderly patients experiencing MSE.
• MSE duration and etiology significantly impact clinical outcomes and mortality in the elderly population.