Towne Alan R
Department of Neurology, Virginia Commonwealth University, Richmond, Virginia 23298, USA.
Int Rev Neurobiol. 2007;81:111-27. doi: 10.1016/S0074-7742(06)81007-X.
Status epilepticus (SE) is a serious condition of prolonged or repetitive seizures. The annual incidence (86/100,000) of SE in the elderly who are aged 60 and greater is almost twice that of the general population and is even higher in those who are 70 years and older. Either acute or remote symptomatic stroke causes approximately 60% of SE seen in the elderly. SE is associated with a high mortality in the elderly (38%), with a rate approaching 50% in patients older than 80 years of age. Etiology is a strong determinant of mortality in the elderly: mortality approaches 100% in patients with anoxia and 30% in patients with either metabolic disorders, hemorrhages, tumors, or systemic infections. Mortality is almost three times higher in SE associated with acute ischemic stroke than in stroke alone, indicating synergistic effects. Duration of SE is also a factor in mortality. Treatment should be initiated for any convulsive seizure that lasts at least 10 min or is repetitive. An electroencephalogram (EEG) should be promptly obtained so that a diagnosis can be made without delay. Because older patients have a greater likelihood of nondiagnostic findings on routine EEGs, prolonged EEG recordings and inpatient video-EEG monitoring significantly increase the rate of establishing a definitive diagnosis. Nonconvulsive status epilepticus in the elderly is especially difficult to diagnose and should be evaluated with an EEG. Treatment of SE is complicated by altered pharmacokinetics in the elderly. Initial treatments, usually the administration of an intravenous benzodiazepine, have overall success rates of 55% for overt convulsive SE and 14.9% for subtle SE. For refractory SE, little is gained by using additional standard drugs, and general anesthesia with continuous EEG monitoring is recommended.
癫痫持续状态（SE）是一种严重的、发作持续时间延长或反复发作的病症。60岁及以上老年人中SE的年发病率（86/10万）几乎是普通人群的两倍，70岁及以上人群的发病率更高。急性或陈旧性症状性卒中约导致60%的老年SE病例。SE在老年人中与高死亡率相关（38%），80岁以上患者的死亡率接近50%。病因是老年人死亡率的一个重要决定因素：缺氧患者的死亡率接近100%，代谢紊乱、出血、肿瘤或全身感染患者的死亡率为30%。与急性缺血性卒中相关的SE的死亡率几乎是单纯卒中的三倍，表明存在协同作用。SE的持续时间也是死亡率的一个因素。对于任何持续至少10分钟或反复发作的惊厥性发作都应开始治疗。应立即进行脑电图（EEG）检查，以便及时做出诊断。由于老年患者在常规EEG上出现非诊断性结果的可能性更大，延长EEG记录时间和住院视频EEG监测可显著提高确诊率。老年非惊厥性癫痫持续状态尤其难以诊断，应通过EEG进行评估。老年人SE的治疗因药代动力学改变而变得复杂。初始治疗通常是静脉注射苯二氮䓬类药物，显性惊厥性SE的总体成功率为55%，隐匿性SE为14.9%。对于难治性SE，使用额外的标准药物收效甚微，建议在持续EEG监测下进行全身麻醉。
