Status epilepticus in older patients - Epidemiology and treatment options

Status epilepticus (SE) is a medical and neurological emergency that has be en associated with significant morbidity and mortality. The most widely acc epted definition of SE is more than 30 minutes of either continuous seizure activity, or intermittent seizures without full recovery of consciousness between seizures. SE is a major clinical concern in the elderly population, both because it has increased incidence in the elderly compared with the g eneral population. and because of concurrent medical conditions that are mo re likely to complicate therapy and worsen prognosis in elderly individuals . The incidence of SE in the elderly is almost twice that of the general popu lation at 86 per 100 000 per year. With the anticipated growth of the elder ly population, SE is likely to become an increasingly common problem facing clinicians, and an important public health issue. The elderly have the hig hest SE-associated mortality of any age group at 38%, and the very old elde rly (>80 years of age) have a mortality of at least 50%. Acute or remote st roke is the most common aetiology of SE in the elderly. Nonconvulsive SE (N CSE) has a wide range of clinical presentations, ranging from confusion to obtundation. It occurs commonly in elderly patients who are critically ill and in the setting of coma. Electroencephalogram is the only reliable metho d of diagnosing NCSE. The goal of treatment for SE is rapid cessation of clinical and electrical seizure activity. Most treatment protocols call for the immediate administr ation of an intravenous benzodiazepine, followed by phenytoin or fosphenyto in. Recent studies suggest that when this initial treatment of SE fails, li ttle is gained by using additional standard drugs. General anaesthetic agen ts (such as pentobarbital, midazolam, or propofol) should be expeditiously employed, although these treatments have their own potential complications. Intravenous valproic acid is a recent addition to the armamentarium of dru gs for the treatment of SE, with a low risk of hypotension, respiratory dep ression and hypotension, making it a potentially useful drug for the treatm ent of SE in the elderly. However, further information is needed to establi sh its role in the overall treatment of SE.