Canas Nuno, Delgado Henrique, Silva Vanessa, Pinto Ana Rita, Sousa Sandra, Simões Rita, Inácio Nuno, Vale José
Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal; Institute of Pharmacology and Neurosciences, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.
Neurology Department, Hospital das Forças Armadas, Lisbon, Portugal.
Epilepsy Behav. 2018 Feb;79:53-57. doi: 10.1016/j.yebeh.2017.10.034. Epub 2017 Dec 15.
Nonconvulsive status epilepticus (NCSE) in the elderly is particularly difficult to diagnose, mainly due to subtle clinical manifestations and associated comorbidities. The recently validated electroencephalography (EEG) diagnostic criteria for NCSE and the proposed operational classification of status epilepticus provide tools that can allow an earlier diagnosis and better management of NCSE in this age group, possibly contributing to reduce its high mortality.
we used these tools to identify and characterize a cohort of elderly (>60year-old) patients admitted at our institution in a 3-year period; the video-EEG and clinical files of the patients fulfilling EEG diagnostic criteria for NCSE were reviewed, being in this study described their electroclinical spectrum, etiologies, treatment, inhospital mortality, and status epilepticus severity score (STESS).
Fourty patients (23 women; mean age 76.6years) were identified. Although dyscognitive NCSE associated with >2.5Hz of epileptiform discharges (ED) was the most frequent electroclinical phenotype, this was quite heterogeneous, ranging from patients with aura continua to patients in coma, associated with frequent ED or rhythmic slow activities. Acute symptomatic (45%) and multifactorial (27.5%) etiologies were the most common, and associated with the worst prognosis. There was a trend to use newer antiepileptic drugs in the early steps of NCSE treatment. The inhospital mortality was high (22.5%) and predicted by STESS scores ≥3.
In the elderly, NCSE has heterogeneous electroclinical phenotypes and etiologies. In spite of the treatment limitations conditioned by the comorbidities, more aggressive treatments could be justified to reduce mortality in patients with high STESS scores.
老年非惊厥性癫痫持续状态（NCSE）特别难以诊断，主要是由于临床表现隐匿以及存在相关合并症。最近经过验证的NCSE脑电图（EEG）诊断标准以及提议的癫痫持续状态操作分类提供了一些工具，能够对该年龄组的NCSE进行更早诊断和更好管理，可能有助于降低其高死亡率。
我们使用这些工具来识别和描述在3年期间入住我们机构的老年（>60岁）患者队列；对符合NCSE的EEG诊断标准的患者的视频EEG和临床档案进行了回顾，在本研究中描述了他们的电临床谱、病因、治疗、住院死亡率和癫痫持续状态严重程度评分（STESS）。
共识别出40例患者（23名女性；平均年龄76.6岁）。尽管与>2.5Hz癫痫样放电（ED）相关的认知障碍性NCSE是最常见的电临床表型，但这种表型非常异质，范围从存在持续性先兆的患者到昏迷患者，伴有频繁的ED或节律性慢波活动。急性症状性（45%）和多因素（27.5%）病因最为常见，且与最差的预后相关。在NCSE治疗的早期阶段有使用新型抗癫痫药物的趋势。住院死亡率很高（22.5%），且由STESS评分≥3预测。
在老年人中，NCSE具有异质的电临床表型和病因。尽管合并症会限制治疗，但对于STESS评分高的患者，采取更积极的治疗以降低死亡率是合理的。
