Diferencias en el manejo de las crisis epilépticas entre los ancianos y los adultos más jóvenes atendidos en un servicio de urgencias

Abstract

To study the differences in the management and short-term outcomes of adult patients treated in an emergency service for epileptic seizures, depending on whether they are elderly or not. This observational retrospective cohort study included all the patients over 15 years of age who were treated for epileptic seizures in the hospital emergency department of a tertiary and university hospital between 1 September and 31 December 2011. The variables collected were acute treatment and follow-up at 30 days after the index event in the emergency department. Altogether the sample included 114 patients with a mean age of 46.4 years (interquartile range: 32.6-74.3 years), of whom 34 (29.8%) were aged 65 years or over. The group of elderly persons presented a first epileptic episode (p = 0.001), with unknown precipitating factor (p = 0.02), structural causation (p < 0.001), a computerised tomography scan carried out in the emergency department (p < 0.001), establishment of preventive antiepileptic drug regime in the emergency department (p = 0.001) and a prolonged hospital stay (p = 0.002) more frequently than the younger adults. Following a multivariable analysis, being elderly was an independent factor associated to a greater need for specific complementary tests (odds ratio = 3.7; 95% confidence interval = 1.3-10.3) and pharmacological intervention in the emergency department (odds ratio = 3.3; 95% confidence interval = 1.4-8.1). There were no statistically significant differences in the results between the two groups at 30 days in terms of return visits (p = 0.316) and mortality (p = 0.087). The treatment of epileptic seizures in the elderly in the emergency department is complex, if compared with younger adults, thereby making it necessary to use a greater amount of hospital resources.