Abstracts

Rationale: Status epilepticus (SE) is a serious medical condition associated with significant morbidity and mortality. Few studies have addressed this condition in the elderly. The present study examines characteristics of SE in this growing population. To achieve these objectives we will utilize a validated population based database. The population in the United States will see a dramatic increase in the elderly population over the next 50 years. Previously, it was felt that the largest percentage of patients with seizures were in the younger age groups. More recent data suggest that the elderly population contain a growing percentage of patients with seizures. SE is a particularly deadly form of seizure with a mortality exceeding 25%, in some series. However the characteristics of this deadly condition are little known the elderly population. The ability to recognize and appropriately treat this condition will hopefully reduce the mortality and morbidity associated with SE.Methods: This is a descriptive longitudinal cross-sectional prospective population based study. We utilized a large population-based, prospectively collected database of SE cases presenting in the Richmond Metropolitan Area from July 1, 1989, to June 30, 2006. SE cases were identified during the course of this study at the Virginia Commonwealth University Health System. The characteristics of elderly patients presenting with SE including age, race, sex, duration of seizures, mortality, response to treatment, and seizure presentation were analyzed. Results: A total of 2,220 patients were included for this analysis. One thousand four hundred and seventy-five patients (66.4%) were included in the young group which included ages from 30 days up to but not including age 60. The elderly group was comprised of 745 patients (33.6%) and included ages from age 60 and above. There were 1,035 females comprising 46.6% of the total population and 1,185 males at 53.4%. The most frequent type of status epilepticus was the group partial seizures with secondary generalization. African American patients accounted for the largest percentage of patients at 57.2%, white patients accounted for 35.8% and other races, predominantly Hispanic, accounted for 7%. The etiology of SE, in our patients, was categorized into seven broad sub-groups. The most common etiologies were in the non CNS and CNS acute categories. Low anticonvulsant levels and remote symptomatic etiologies were also seen frequently. Certain etiologies had significantly higher mortalities when compared to other etiologies. An especially high mortality was observed in the hypoxia group. Mortality in the elderly group (26.5%) was significantly higher than in the young group (OR=3.54 CI 2.53 ,4.95). Analysis of the age groups demonstrated that the odds ratio for mortality increased significantly from 0.41 to 7.79.Conclusions: SE is a serious medical condition, consisting of prolonged seizure activity, associated with a significant mortality. Elderly patients with SE represent a distinct population with unique characteristics. Funding: Supported by NIH P50 NS25630.