Abstracts

Rationale: Status epilepticus (SE) constitutes an important neurologic emergency among the elderly and focused study in this subgroup of patients who manifested with critical seizures i.e. SE and cluster of seizures are far and few. To evaluate the frequency, therapeutic response and predictors of critical presentation of seizures among the elderly Methods: Elderly patients with epilepsy >60 years (n=201; age: 68.0,SD:7.5) were prospectively recruited. Sixty four (32%)patients who presented with cluster attacks and/or status epilepticus(SE)were considered to have critical seizures. All underwent EEG and CT scan. Results: The mean duration of critical seizures was 14.9 53.7 hours. Cluster attacks were observed in 53 (26.4%) and SE in 34 (17%). The types of SE were generalized convulsive (23), epilepsia partialis continua (8), non-convulsive (2) and myoclonic (1). The types of epilepsy syndrome included acute symptomatic - 37 (57.8%), cryptogenic - 15 (23.4%), and remote symptomatic - 12 (18.8%). Interictal EEG was abnormal in 79.7% of patients with critical presentation vs. 53.3% of patients without critical presentation. Epileptiform activity was observed in 46.9% of patients with critical presentation vs. 27.0% without critical presentation (p=0.001). The neuroimaging differences in two groups were absence of white-matter changes on CT in those with vs. without critical presentation (28.1% vs. 41.6%, p=0.06). The markers for critical seizures were - acute symptomatic seizures, simple partial seizures, and higher number of seizures, lower GCS score, and absence of white-matter changes on CT. After multivariate analysis, lower GCS score (p=0.01; OR = 0.82), and more number of seizures (p=0.03; OR = 1.03) significantly predicted the critical presentation. Seizures were controlled with 2 AEDs in 70.6%. Conclusions: Critical presentation of seizures was common (32%) among elderly. Early and aggressive treatment is effective in the majority.