Status epilepticus: A common presentation of first seizure in the elderly.

Clinical bottom line (level 4)

  1. Status epilepticus occurred in a third of elderly patients presenting with a first seizure.
  2. The commonest causes for status epilepticus were stroke, head injury and multifactorial causes.
Sung and Chu: Acta Neurologica Scandinavia 1989; 80: 51-56
Expires September 2003

The study

Retrospective cohort study with objective outcomes, not adjusted for confounding factors, ? validated in an independent set of patients.

Setting: Neurology department at a teaching hospital.

102 patients (aged > 60, 68% male) first seizure and status epilepticus defined as seizure lasting > 30 minutes or two or more major convulsions without regaining consciousness between them

Excluded if
  • did not have head CT


    • Cases: 106 patients (68% male, mean age 60):
    Controls: ?patients : no control group

    Factors studied:
  • stroke
  • head injury
  • sub-arachnoid haemorrhage
  • multifactorial
  • metabolic disorder
    • brain tumour
  • CNS infection
  • unknown


    • Factors summarised:

    Outcomes studied:
  • status epilepticus

    • The evidence

    Patient expected event rate for status epilepticus: 29.8%
    • Stroke 29.4%
    • Sub-arachnoid haemorrhage 5.88%
    • Head injury 20.6%
    • Tumours 7.8%
    • Metabolic disorder 9.8%
    • Multi-factorial 10.9%
    • CNS infection 2.9%
    • Undetermined 12.7%

    Comments

    1. The frequency of status for first seizure is very high in this study. However, it is one of few studies that report the prevalence of status in patients who fit.
    2. Other case series have shown that alcohol withdrawal and sudden stopping of anticonvulsant medication are common causes in patients who have fitted previously.

    Citation

    1. Sung CY, and Chu NS: Status epilepticus in the elderly: etiology, seizure type and outcome.. Acta Neurologica Scandinavia 1989; 80: 51-56
    Contributor: Chris Ball and Musab Hayatli, Unknown Month 2000
    Reviewer:

    Clinical Question.
    Patient elderly patients
    Intervention or Exposure first seizure
    Outcome cause