Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil.
Department of Neurology, Hospital São Rafael, D'Or Institute for Research and Education (IDOR) - Av. São Rafael, 2152, ZC: 41253-190 Salvador, Bahia, Brazil.
Epilepsy Behav. 2019 Sep;98(Pt A):145-152. doi: 10.1016/j.yebeh.2019.07.004. Epub 2019 Jul 30.
Early seizure recurrence is common among elderly inpatients and is related to increased morbidity and a longer length of hospital stay. There are few studies on the short-term outcomes of seizures in the elderly population. We aimed to identify the predictors of early seizure recurrence among elderly inpatients.
We prospectively enrolled patients aged 60 years and older from a tertiary center who had seizures that either led to their hospital admission or occurred during hospitalization. We analyzed the demographic and hospitalization data, characteristics and etiology of seizures, and neurological and clinical comorbidities. Kaplan-Meier analysis was performed to determine the 30-day cumulative recurrence rates. The logrank test was used to analyze the risk of seizure recurrence within 30 days after the index seizure. Multivariable logistic regression analysis was used to identify risk factors for the recurrence of seizures within 30 days.
Overall, 109 patients (mean age: 75.9 ± 9.6 years) were enrolled. The mean age at the first-ever seizure was 74 ± 11.7 years. Unprovoked seizures occurred in 59.6% of the patients. Cerebrovascular disorders were the most prevalent etiology (52.3%). Early seizure recurrence, defined as within 30 days, occurred in 27.5% of patients. Multimorbidity was found in 95.4% of our inpatients (6.3 ± 2.3 [95% confidence interval, 5.4-7.2]), and the number of comorbidities was higher among those who had seizure recurrence than that among those who did not have seizure recurrence (p = 0.02). The probability of seizure recurrence was similar among the subgroups of patients who experienced acute seizures versus unprovoked seizures (both p = 0.03), and seizure recurrence was associated with a longer length of hospital stay (p = 0.005) compared to that of patients who did not experience seizure recurrence. After multivariate analysis, sepsis (p = 0.011), psychiatric disorders (p = 0.032), and cardiac arrhythmias (p = 0.037) were identified as risk factors for early seizure recurrence.
Higher multimorbidity and a longer length of stay were associated with early seizure recurrence; and sepsis, psychiatric disorders, and cardiac arrhythmias were independent risk factors for early seizure recurrence among elderly inpatients.
老年人住院患者中早期癫痫发作复发较为常见，与发病率增加和住院时间延长有关。关于老年人癫痫发作的短期结局的研究较少。我们旨在确定老年人住院患者早期癫痫发作复发的预测因素。
我们前瞻性地招募了来自一家三级中心的年龄在 60 岁及以上的患者，这些患者的癫痫发作导致其入院或在住院期间发生。我们分析了人口统计学和住院数据、癫痫发作的特征和病因以及神经和临床合并症。进行 Kaplan-Meier 分析以确定 30 天内累积复发率。对数秩检验用于分析指数发作后 30 天内癫痫发作复发的风险。多变量逻辑回归分析用于确定 30 天内癫痫复发的危险因素。
总体而言，共纳入 109 例患者（平均年龄：75.9±9.6 岁）。首次癫痫发作的平均年龄为 74±11.7 岁。无诱因的癫痫发作占 59.6%。脑血管疾病是最常见的病因（52.3%）。定义为 30 天内的早期癫痫发作复发率为 27.5%。我们的住院患者中有 95.4%（6.3±2.3 [95%置信区间，5.4-7.2]）存在多种合并症，且发生癫痫发作复发的患者的合并症数量高于未发生癫痫发作复发的患者（p=0.02）。经历急性癫痫发作的患者与无诱因癫痫发作的患者亚组之间的癫痫发作复发概率相似（两者均 p=0.03），与未经历癫痫发作复发的患者相比，癫痫发作复发与住院时间延长相关（p=0.005）。多变量分析后，确定脓毒症（p=0.011）、精神障碍（p=0.032）和心律失常（p=0.037）是早期癫痫发作复发的危险因素。
较高的多种合并症和较长的住院时间与早期癫痫发作复发相关；脓毒症、精神障碍和心律失常是老年人住院患者早期癫痫发作复发的独立危险因素。
