Elderly patients with nonconvulsive status epilepticus: Clinical-EEG data, hospital mortality, STESS and EMSE

Abstract

Purpose To assess the clinical-EEG aspects, characterization of subtypes, relationships with prognostic scales and the occurrence of death in elderly patients in the acute phase of nonconvulsive status epilepticus (NCSE).Methodology Clinical variables, EEG data, Status epilepticus severity score (STESS), and the Epidemiology-based mortality score in status epilepticus (EMSE) were related to the death of 96 patients who were over 60 years old, with NCSE.Results NCSE with coma was observed in 31 patients (19 non-subtle and 12 “subtle” SE) and focal NCSE with impairment of consciousness in 65 cases. There were no significant EEG differences according to the type of NCSE. Higher STESS scores occurred in the comatose NCSE patients when compared to those with focal NCSE and impairment of consciousness (4.8 ± 1.2 vs 3.7 ± 1.2; T-Test; p<0.001). It was observed that 25 (26%) elderly died, with a mean survival time of 19.3 days. Elderly people with a higher risk of death are those diagnosed with NCSE with coma (HR 2.76; 95% CI 1.15–6.65; p = 0.023), with STESS≥3 (HR 16.0; CI 1.77–45.08; p = 0.014), with EMSE≥64 (HR 3.67; CI 1.54–8.72; p = 0.003), and those with no history of recurrent SE (HR 6.80; CI 1.42–32.64; p = 0.017), in Cox regression.Conclusion The ictal EEG patterns did not distinguish the subtypes of NCSE. Thirty-day mortality rate was high in elderly patients with NCSE. The clinical variables are related to prognosis. Mortality in the elderly was associated with comatose NCSE patients, with STESS≥3, with EMSE≥64, and no history of recurrent SE.