Status epilepticus in the elderly

Abstract

Status epilepticus (SE) is a common neurological emergency with high morbidity and mortality, and its incidence is especially high in elderly people. As Japanese population is rapidly aging, SE in the elderly is increasingly becoming an important clinical problem. We outline in this review the epidemiology, clinical characteristics, and treatment of SE in the elderly. Epidemiological studies in the United States and Europe showed the incidence of 15–86/100000/year, and the mortality of 22–38%, in elderly people. Compared to younger SE, elderly SE more frequently occurs de novo ; is less likely to be tonic–clonic but more likely to be focal motor or nonconvulsive ; and is more frequently refractory, particularly refractory nonconvulsive. Cerebrovascular disease and dementia are the major etiologies. As nonconvulsive SE is common in elderly people, electroencephalography must be performed when they have acute impaired consciousness without known causes. Although SE in the elderly should be treated basically according to the treatment guidelines, the characteristics of elderly persons (individual differences in pharmacokinetic and pharmacodynamic parameters, comorbidities, and medications) also must be taken into account. Moreover, adverse effects and underlying disease severities should be carefully balanced, particularly in elderly nonconvulsive SE.