PMID- 9821984
OWN - NLM
STAT- MEDLINE
DCOM- 19981201
LR  - 20220318
IS  - 0013-9580 (Print)
IS  - 0013-9580 (Linking)
VI  - 39
IP  - 11
DP  - 1998 Nov
TI  - Nonconvulsive status epilepticus in the critically ill elderly.
PG  - 1194-202
AB  - PURPOSE: To describe the electrographic and clinical features of nonconvulsive 
      status epilepticus (NCSE) in the critically ill elderly and to identify potential 
      predictors of outcome. METHODS: We prospectively identified 25 episodes of 
      altered mentation and NCSE in 24 critically ill elderly patients associated with 
      generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with 
      anoxic encephalopathy were excluded. RESULTS: Of 25 hospitalizations, 13 (52%) 
      resulted in death, and 12 (48%) patients survived to discharge. Death was 
      associated with the number of acute, life-threatening medical problems on 
      presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized 
      EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs 
      (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was 
      associated with increased risk of death (p = 0.033). Ten patients with advance 
      directives were managed outside the intensive care unit (ICU). Mean 
      hospitalization was 39 days in the ICU group and 22 for those with advance 
      directives (p = 0.017). CONCLUSIONS: Severity of illness correlates with 
      mortality in critically ill elderly patients with NCSE. Treatment with 
      intravenous benzodiazepines may increase their risk of death. Aggressive ICU 
      management may prolong hospitalization at considerable cost, without improving 
      outcome. It is unclear whether NCSE affects outcome in the critically ill elderly 
      or is merely a marker for severity of disease in predisposed patients. The 
      benefits of aggressive therapy are unclear. Carefully controlled, prospective 
      trials will be necessary to determine the best therapies for NCSE in the 
      critically ill elderly and the appropriate role of the ICU in their management.
FAU - Litt, B
AU  - Litt B
AD  - Emory University Department of Neurology, Atlanta, Georgia, USA.
FAU - Wityk, R J
AU  - Wityk RJ
FAU - Hertz, S H
AU  - Hertz SH
FAU - Mullen, P D
AU  - Mullen PD
FAU - Weiss, H
AU  - Weiss H
FAU - Ryan, D D
AU  - Ryan DD
FAU - Henry, T R
AU  - Henry TR
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Epilepsia
JT  - Epilepsia
JID - 2983306R
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Critical Care
MH  - *Electroencephalography
MH  - Hospitalization
MH  - Humans
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Outcome Assessment, Health Care
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Status Epilepticus/*diagnosis
MH  - Terminally Ill
EDAT- 1998/11/20 00:00
MHDA- 1998/11/20 00:01
CRDT- 1998/11/20 00:00
PHST- 1998/11/20 00:00 [pubmed]
PHST- 1998/11/20 00:01 [medline]
PHST- 1998/11/20 00:00 [entrez]
AID - 10.1111/j.1528-1157.1998.tb01311.x [doi]
PST - ppublish
SO  - Epilepsia. 1998 Nov;39(11):1194-202. doi: 10.1111/j.1528-1157.1998.tb01311.x.