Abstract
The aim of the study was to review the epidemiology, clinical profile and discuss the etiology, prognosis and treatment options in patients aged 60 years or older presenting with status epilepticus. We performed a systematic review involving studies published from 1996 to 2010, in Medline/PubMed, Scientific Electronic Library on line (Scielo), Latin-American and Caribbean Center of Health Sciences Information (Lilacs) databases and textbooks. Related articles published before 1996, when relevant for discussing epilepsy in older people, were also included. Several population studies had shown an increased incidence of status epilepticus after the age of 60 years. Status epilepticus is a medical and neurological emergency that is associated with high morbidity and mortality, and is a major concern in the elderly compared to the general population. Prompt diagnosis and effective treatment of convulsive status epilepticus are crucial to avoid brain injury and reduce the fatality rate in this age group.
Highlights
Refractory status epilepticus (RSE) is defined as Status epilepticus (SE) that does not respond after initial therapy with a minimum number of two or three anticonvulsant drugs (ACD) or SE with seizures minimum duration of 1-2 h despite the Table 1 published in Rev Neurol 2003;36 (7): 661-679
The elderly have a greater risk of cerebrovascular diseases, and degenerative and metabolic disorders that contribute to seizures occurrence
non-convulsive SE (NCSE) is characterized by some clinically evident alteration in mental status or behavior from baseline, without signs of convulsions, lasting at least 30 min, with a pattern of seizure activity on the electroencephalogram that disappears with the treatment and recovery of consciousness.[6,13] habitants, with a bimodal distribution curve (U), with the highest incidence rates seen in children under the age of one year and in adults aged 60 years and above
Summary
Patients in SE often present with no convulsive activity or less apparent clinical manifestations that can be underecognized. Drugs Aging effect.[5,6] While the patient is in a pentobarbital coma, EEG is the only reliable method to ly assess cessation of convulsive seizures, and the EEG pattern should change from epileptin form patterns to either burst-suppression or o electrocerebral inactivity.[3,6,8] according to various studies pentobarbital is efficae cious in the treatment of RSE, it has been s associated with high mortality.[5,6,8,58] Infusion u should be slowed down if profound hypotension occurs, with addition of pressor agents if l needed.[8] cia Midazolam r Midazolam is a water-soluble benzodie azepine with a short half-life of 4-6 hours and rapid onset of action. The lack of an intravenous form makes acute administration of topiramate difficult.[8]
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