État de mal épileptique de la personne âgée. Étude rétrospective de 63 patients hospitalisés
L’état de mal épileptique de la personne âgée est une pathologie peu étudiée. Cette étude rétrospective sur deux ans présente les caractéristiques cliniques, électro-encéphalographiques et radiologiques de 63 patients âgés de plus de 70 ans, hospitalisés et ayant présenté un état de mal épileptique....
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Published in | Revue neurologique Vol. 164; no. 11; pp. 935 - 942 |
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Main Authors | , , , , |
Format | Journal Article |
Language | French |
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Elsevier Masson SAS
01.11.2008
Masson |
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Abstract | L’état de mal épileptique de la personne âgée est une pathologie peu étudiée.
Cette étude rétrospective sur deux ans présente les caractéristiques cliniques, électro-encéphalographiques et radiologiques de 63 patients âgés de plus de 70 ans, hospitalisés et ayant présenté un état de mal épileptique.
Nous avons retrouvé deux tiers de femmes et un tiers d’hommes, d’âge moyen de 83
ans. L’incidence était de 1 %. Le type d’état de mal était partiel complexe dans 91 % des cas avec un syndrome confusionnel (89 %), des troubles de vigilance (75 %) ou des symptômes psychiatriques (43 %). L’étiologie était souvent multifactorielle : métabolique (60 %), iatrogène (51 %), démentielle (44 %), cérébrovasculaire (37 %), septique (30 %) ou d’autres neurologiques (28 %). Le traitement antiépileptique utilisé pour traiter l’état de mal épileptique était le plus souvent une benzodiazépine (60 %), associée à la lamotrigine (Lamictal
®) (51 %), le valproate (Dépakine
®) (46 %) ou la phénytoïne (Di-hydan
®) (25 %). Les complications étaient fréquentes : perte d’autonomie (86 %), dénutrition (67 %), infections (51 %), troubles cognitifs (30 %), escarres (14 %), épilepsie séquellaire (13 %). Le taux de mortalité était de 32 % des cas et était plus fréquent chez les hommes.
L’état de mal épileptique de la personne âgée est une pathologie peu fréquente et de type partiel complexe, le plus souvent, d’origine multifactorielle et de mauvais pronostic.
Status epilepticus is quite frequent in the elderly but rarely studied despite the poor functional prognosis and significant mortality.
We retrospectively evaluated the clinical manifestations and electroencephalogram findings observed over a two-year period in 63 consecutive inpatients aged over 70 years presenting status epilepticus. The variables studied included age, sex, the number of concomitant chronic active diseases, previous neurological disorders, brain lesions on CT or MRI, the use and withdrawal of medications and outcome.
The incidence of status epilepticus was 1%; two-thirds in women and one-third in men. The mean age was 83 years. Complex partial status epilepticus was noted in 91% with predominant features of confusion (89%), impairment of consciousness (75%) or psychiatric symptoms (46%). Etiologies were often multifactorial and acute symptomatic. Etiology was metabolic in 60%, drug-induced in 51%, demential in 44%, cerebrovascular in 37%, infectious in 30% and other neurological disorders in 28% of the cases. Antiepileptic drugs used to treat status epilepticus were benzodiazepine (60%), often in association with lamotrigine (51%), valproate (46%) or phenytoin (25%). Maintenance of an antiepileptic drug was found in 70% of cases. Complications were loss of autonomy (86%), malnutrition (67%), infections (51%), dementia (30%), pressure sores (14%), and recurrent epilepsy (13%). Mortality was 32% of cases and it was higher in men.
These findings have shown some special features of status epilepticus among the elderly but other prospective studies are needed to confirm these results and to identify optimal management to decrease mortality, and improve the poor functional prognosis. |
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AbstractList | L’état de mal épileptique de la personne âgée est une pathologie peu étudiée.
Cette étude rétrospective sur deux ans présente les caractéristiques cliniques, électro-encéphalographiques et radiologiques de 63 patients âgés de plus de 70 ans, hospitalisés et ayant présenté un état de mal épileptique.
Nous avons retrouvé deux tiers de femmes et un tiers d’hommes, d’âge moyen de 83
ans. L’incidence était de 1 %. Le type d’état de mal était partiel complexe dans 91 % des cas avec un syndrome confusionnel (89 %), des troubles de vigilance (75 %) ou des symptômes psychiatriques (43 %). L’étiologie était souvent multifactorielle : métabolique (60 %), iatrogène (51 %), démentielle (44 %), cérébrovasculaire (37 %), septique (30 %) ou d’autres neurologiques (28 %). Le traitement antiépileptique utilisé pour traiter l’état de mal épileptique était le plus souvent une benzodiazépine (60 %), associée à la lamotrigine (Lamictal
®) (51 %), le valproate (Dépakine
®) (46 %) ou la phénytoïne (Di-hydan
®) (25 %). Les complications étaient fréquentes : perte d’autonomie (86 %), dénutrition (67 %), infections (51 %), troubles cognitifs (30 %), escarres (14 %), épilepsie séquellaire (13 %). Le taux de mortalité était de 32 % des cas et était plus fréquent chez les hommes.
L’état de mal épileptique de la personne âgée est une pathologie peu fréquente et de type partiel complexe, le plus souvent, d’origine multifactorielle et de mauvais pronostic.
Status epilepticus is quite frequent in the elderly but rarely studied despite the poor functional prognosis and significant mortality.
We retrospectively evaluated the clinical manifestations and electroencephalogram findings observed over a two-year period in 63 consecutive inpatients aged over 70 years presenting status epilepticus. The variables studied included age, sex, the number of concomitant chronic active diseases, previous neurological disorders, brain lesions on CT or MRI, the use and withdrawal of medications and outcome.
The incidence of status epilepticus was 1%; two-thirds in women and one-third in men. The mean age was 83 years. Complex partial status epilepticus was noted in 91% with predominant features of confusion (89%), impairment of consciousness (75%) or psychiatric symptoms (46%). Etiologies were often multifactorial and acute symptomatic. Etiology was metabolic in 60%, drug-induced in 51%, demential in 44%, cerebrovascular in 37%, infectious in 30% and other neurological disorders in 28% of the cases. Antiepileptic drugs used to treat status epilepticus were benzodiazepine (60%), often in association with lamotrigine (51%), valproate (46%) or phenytoin (25%). Maintenance of an antiepileptic drug was found in 70% of cases. Complications were loss of autonomy (86%), malnutrition (67%), infections (51%), dementia (30%), pressure sores (14%), and recurrent epilepsy (13%). Mortality was 32% of cases and it was higher in men.
These findings have shown some special features of status epilepticus among the elderly but other prospective studies are needed to confirm these results and to identify optimal management to decrease mortality, and improve the poor functional prognosis. |
Author | Verstichel, P. Herbaud, S. Taillandier-Heriche, E. Paillaud, E. Darcel, G. |
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Cites_doi | 10.1212/WNL.50.3.735 10.1212/WNL.55.5.693 10.2165/00002512-200118020-00006 10.1016/S0733-8619(18)30112-9 10.1111/j.1600-0404.1989.tb03842.x 10.1159/000180580 10.1212/WNL.46.4.1029 10.1016/0165-1781(92)90005-N 10.1111/j.1532-5415.1984.tb06303.x 10.1111/j.1528-1157.1998.tb01311.x 10.1016/S1164-6756(05)80545-6 10.1016/S0140-6736(74)91639-0 10.1016/S0140-6736(00)02149-8 10.7326/0003-4819-103-2-276 10.1046/j.1528-1157.2003.63702.x 10.1046/j.1528-1157.2001.01101.x 10.1177/155005949903000403 10.1097/01.wnp.0000220837.99490.66 10.1016/0022-3956(75)90026-6 |
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Keywords | Mortalité Mortality Personne âgée Devenir État de mal épileptique Status epilepticus Elderly Outcomes Incidence Pathologie de l'encéphale Epilepsie Pathologie du système nerveux Pathologie du système nerveux central Etat mal épileptique Homme Rétrospective Etat de mal épileptique |
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Snippet | L’état de mal épileptique de la personne âgée est une pathologie peu étudiée.
Cette étude rétrospective sur deux ans présente les caractéristiques cliniques,... |
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SubjectTerms | Devenir Elderly Incidence Mortality Mortalité Neurologie Outcomes Personne âgée Sciences biologiques et medicales Sciences medicales Status epilepticus Syndromes encéphaliques généraux: céphalées, douleurs de la face, syncopes, épilepsie, hypertension intracrânienne, oedème cérébral. Infirmité motrice cérébrale Système nerveux (sémiologie, syndromes) État de mal épileptique |
Title | État de mal épileptique de la personne âgée. Étude rétrospective de 63 patients hospitalisés |
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