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Status Epilepticus Characteristics and Treatment Strategies in Elderly. an Italian Multicenter, Retrospective, Real-world Study

Abstract number : 3.337
Submission category : 4. Clinical Epilepsy / 4C. Clinical Treatments
Year : 2024
Submission ID : 654
Source : www.aesnet.org
Presentation date : 12/9/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Michelangelo Dasara, MD, cPhD – Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara

Fedele Dono, MD, MSc, cPHD, FEBN – Deparment of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara
Giacomo Evangelista, MD, cPhD – Department of Neuroscience, Imaging and Clinical Science, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
Paolo Quintieri, MD – Department of Neuroscience, Imaging and Clinical Science, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
Sara Cipollone, MD – Department of Neuroscience, Imaging and Clinical Science, “G. D'Annunzio” University of Chieti-Pescara, Chieti, Italy
Clarissa Corniello, MD – Department of Neuroscience Imaging and Clinical Sciences "G. d’Annunzio” University of Chieti-Pescara
Francesca Anzellotti, MD – Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara
Marina Romozzi, MD, PhD – Department of Neuroscience, Catholic University of Sacred Heart, Rome Epilepsy Center, IRCCS “A. Gemelli”, Rome
eleonora rollo, MD, PhD – Department of Neuroscience, Catholic University of Sacred Heart, Rome Epilepsy Center, IRCCS “A. Gemelli”, Rome
Serenella Servidei, MD, PhD – Department of Neuroscience, Catholic University of Sacred Heart, Rome Epilepsy Center, IRCCS “A. Gemelli”, Rome
Paolo Calabresi, MD, PhD – Department of Neuroscience, Catholic University of Sacred Heart, Rome Epilepsy Center, IRCCS “A. Gemelli”, Rome
Catello vollono, MD, PhD – Department of Neuroscience, Catholic University of Sacred Heart, Rome Epilepsy Center, IRCCS “A. Gemelli”, Rome
Stefano Sensi, MD, PhD – 'G. D'Annunzio' University of Chieti Pescara

Rationale: Status Epilepticus (SE) is a neurological emergency with a mortality risk around 20%. SE onset can be observed in all ages, including elderly. Clinical hallmarks as well as the therapeutic approaches of SE in elderly have not been exhaustively explored in the current literature, neither have been their relationship with mortality. Commonly used SE prognostic scales relate to elderlies still are to be evaluated.


Methods: in this retrospective, multi-center, real-world study, patients have been selected from two third-level epilepsy centers between 2016 and 2023. Including criteria were age >75 years old and a diagnosis of SE based on International League Against Epilepsy (ILAE) or Saltzburg criteria for Non Convulsive Status Epilepticus (NCSE). Demographics, clinical as well as SE four axis characteristics (i.e., age, semiology, etiology and EEG correlates) and therapeutic intervention were collected from patient’s clinical folder. STESS, EMSE and CARING scales were evaluated as outcome predictors.


Results: 83 patients (age: 83 ± 6, 28 male) were included. Non-convulsive SE with acute etiology was mainly described. Patients were treated with a mean number of 2.7±1.5 drugs. First-line treatment consisted of diazepam (mean dose: 10.4±3.3 mg) in most of patients followed by levetiracetam (mean dose: 1815.8±931.1 mg). Thirty-three patients developed a refractory SE and 34 patients died for SE. Compared to survivors, patients who died for SE showed an increased prevalence of cardiological comorbidities (p=0.03). Number of comorbidities, age and sex did not correlate with mortality. Otherwise, ASM used as first line treatment resulted in higher mortality. Refractoriness was not a predictor of mortality (r=0.21). Prognostic scale’s specificity and sensibility, respectively, were 74% and 72% for STESS, 41% and 91% for EMSE, 23% and 87% for CARING criteria (even though where not strictly linked with the SE (p=0,4)).


Conclusions:
SE is associated with a great mortality in elderly. Treatment strategies generally consist of benzodiazepine and ASM, the latter having higher mortality when used as a first line therapy. Anesthetics are less employed. Commonly used prognostic scales (i.e., STESS and EMSE) have a good reliability. CARING scale may be employed in elderly patients as outcome predictor tool.




Funding: None.

Clinical Epilepsy