NCSE-coma in older adults: Clinical data, initial EEG, and hospital outcome

• Published in: Epilepsy & behavior Vol. 158; p. 109929
• Main Author: Tedrus, Gloria M.A.S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2024
• Subjects: Aged; Aged, 80 and over; Coma - diagnosis; Coma - etiology; Coma - physiopathology; EEG; Electroencephalography - methods; Female; Humans; Male; Middle Aged; Mortality; Non-convulsive status epilepticus; Older adults; Prognosis; Retrospective Studies; Status Epilepticus - diagnosis; Status Epilepticus - mortality; Status Epilepticus - physiopathology; Treatment Outcome; Non-convulsive status epilepticus; Older adults; EEG; Mortality
• ISSN: 1525-5050; 1525-5069; 1525-5069
• DOI: 10.1016/j.yebeh.2024.109929

•There are distinct clinical-EEG aspects among the types of NCSE-coma.•Mortality rate was high in older adults with NCSE-coma.•The most frequent finding on the initial EEG involves criterion A2 of the Salzburg criteria.•Previous history of seizures and higher SACE scores were more frequent in NCSE-coma with preceding seizure/SE. The clinical-EEG profile and prognosis in nonconvulsive status epilepticus (NCSE-coma) − with preceding SE and without preceding SE – have not been fully established yet. To evaluate the initial EEG, clinical characteristics, and hospital outcome of older adults with NCSE-coma. Clinical variables, immediate prognosis, initial EEG data, and scores on the Status Epilepticus Severity Score (STESS) and the SACE score were evaluated according to the type of NCSE-coma (with and without preceding seizure/SE) in 51 older adult patients treated in the emergency department. The mean age of the participants was 72.2 years. In 23 cases, the diagnosis was NCSE-coma with preceding seizure/SE, and in 28 cases the diagnosis was NCSE-coma without preceding seizure/SE. Previous history of seizures/epilepsy occurred in 11 cases (21.5 %), and was more frequent in NCSE-coma with preceding seizure/SE. The most common etiology was acute. Death within 30 days occurred in 21 cases (41.1 %), but there was no difference between types of NCSE-coma. The predominant EEG finding was the presence of epileptiform discharges/rhythmic delta activity showing morphological/spatial/temporal evolution (classified as A2 in the Salzburg Consensus Criteria [SCC]). There was a significant difference in EEG findings according to the type of NCSE-coma. Total SACE scores averaged 0.9 ± 0.8; on the STESS, it was 4.7 ± 0.4. In the SACE score, the highest total score and a more significant occurrence of scores ≥ 3 (indicating a better prognosis) were observed in NCSE-coma with preceding seizure/SE. In older adults, the types of NCSE-coma presented different clinical aspects and patterns on initial EEG. The mortality rates were elevated. The most prevalent EEG findings encompass criteria A2 of the SCC. A history of previous seizures/epilepsy and a more favorable prognosis in the SACE score occurred in NCSE-coma with preceding seizure/SE.