Nonconvulsive Status Epilepticus in the Elderly: A Case Series and a Review of the Literature

Abstract

Because of age related etiologies and complications, nonconvulsive status epilepticus (NCSE) may have a different prognosis in the elderly than in the young. We prospectively studied clinical characteristics and outcomes of 10 patients over age 65 years with NCSE. All underwent continuous video-electroencephalogram monitoring. Patients’ ages ranged between 65 and 95 years (mean = 80). Three patients had complex partial status epilepticus (CPSE), seven had complex partial and secondarily generalized NCSE, and none had primary generalized NCSE. Causes of NCSE were: stroke (four), metabolic derangement (two), brain neoplasia (one), head injury (one), electroconvulsive therapy (one), and preexisting epilepsy (one). One patient with hyponatremia and one patient with a previous seizure disorder recovered. Five patients were discharged with new neurologic deficits due to underlying processes; four of these patients also had infectious complications during hospitalization. Three patients died, all due to infectious complications. We conclude that NCSE in the elderly is associated with a poor prognosis, because of underlying causative processes and medical complications.