Nonconvulsive status epilepticus in the critically ill elderly

Brian Litt, Robert J. Wityk, Sharon H. Hertz, Paul D. Mullen, Howard Weiss, Dawn D. Ryan, Thomas R. Henry

Research output: Contribution to journalArticle

Abstract

Purpose: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. Methods: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. Results: Of 25 hospitalizations, 13 (52%) resulted in death, and 12 (48%) patients survived to discharge. Death was associated with the number of acute, life-threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). Conclusions: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.

Original languageEnglish (US)
Pages (from-to)1194-1202
Number of pages9
JournalEpilepsia
Volume39
Issue number11
StatePublished - 1998

Fingerprint

Status Epilepticus
Critical Illness
Intensive Care Units
Advance Directives
Hospitalization
Benzodiazepines
Electroencephalography
Brain Hypoxia
Therapeutics
Anticonvulsants
Survivors
Costs and Cost Analysis
Mortality

Keywords

  • Critical illness
  • Elderly
  • Electroencephalography
  • Nonconvulsive status epilepticus
  • Outcome

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Litt, B., Wityk, R. J., Hertz, S. H., Mullen, P. D., Weiss, H., Ryan, D. D., & Henry, T. R. (1998). Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia, 39(11), 1194-1202.

Nonconvulsive status epilepticus in the critically ill elderly. / Litt, Brian; Wityk, Robert J.; Hertz, Sharon H.; Mullen, Paul D.; Weiss, Howard; Ryan, Dawn D.; Henry, Thomas R.

In: Epilepsia, Vol. 39, No. 11, 1998, p. 1194-1202.

Research output: Contribution to journalArticle

Litt, B, Wityk, RJ, Hertz, SH, Mullen, PD, Weiss, H, Ryan, DD & Henry, TR 1998, 'Nonconvulsive status epilepticus in the critically ill elderly', Epilepsia, vol. 39, no. 11, pp. 1194-1202.
Litt B, Wityk RJ, Hertz SH, Mullen PD, Weiss H, Ryan DD et al. Nonconvulsive status epilepticus in the critically ill elderly. Epilepsia. 1998;39(11):1194-1202.
Litt, Brian ; Wityk, Robert J. ; Hertz, Sharon H. ; Mullen, Paul D. ; Weiss, Howard ; Ryan, Dawn D. ; Henry, Thomas R. / Nonconvulsive status epilepticus in the critically ill elderly. In: Epilepsia. 1998 ; Vol. 39, No. 11. pp. 1194-1202.
@article{22ef7eb6176c491196b393e3d6b4c3da,
title = "Nonconvulsive status epilepticus in the critically ill elderly",
abstract = "Purpose: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. Methods: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. Results: Of 25 hospitalizations, 13 (52{\%}) resulted in death, and 12 (48{\%}) patients survived to discharge. Death was associated with the number of acute, life-threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). Conclusions: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.",
keywords = "Critical illness, Elderly, Electroencephalography, Nonconvulsive status epilepticus, Outcome",
author = "Brian Litt and Wityk, {Robert J.} and Hertz, {Sharon H.} and Mullen, {Paul D.} and Howard Weiss and Ryan, {Dawn D.} and Henry, {Thomas R.}",
year = "1998",
language = "English (US)",
volume = "39",
pages = "1194--1202",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Nonconvulsive status epilepticus in the critically ill elderly

AU - Litt, Brian

AU - Wityk, Robert J.

AU - Hertz, Sharon H.

AU - Mullen, Paul D.

AU - Weiss, Howard

AU - Ryan, Dawn D.

AU - Henry, Thomas R.

PY - 1998

Y1 - 1998

N2 - Purpose: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. Methods: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. Results: Of 25 hospitalizations, 13 (52%) resulted in death, and 12 (48%) patients survived to discharge. Death was associated with the number of acute, life-threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). Conclusions: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.

AB - Purpose: To describe the electrographic and clinical features of nonconvulsive status epilepticus (NCSE) in the critically ill elderly and to identify potential predictors of outcome. Methods: We prospectively identified 25 episodes of altered mentation and NCSE in 24 critically ill elderly patients associated with generalized, focal, or bihemispheric epileptiform EEG patterns. Patients with anoxic encephalopathy were excluded. Results: Of 25 hospitalizations, 13 (52%) resulted in death, and 12 (48%) patients survived to discharge. Death was associated with the number of acute, life-threatening medical problems on presentation (survivors, 1.8; fatalities, 2.8; p = 0.013) and with generalized EEG pattern (p = 0.017). Higher doses or greater number of antiepileptic drugs (AEDs) did not improve outcome. Treatment with intravenous benzodiazepines was associated with increased risk of death (p = 0.033). Ten patients with advance directives were managed outside the intensive care unit (ICU). Mean hospitalization was 39 days in the ICU group and 22 for those with advance directives (p = 0.017). Conclusions: Severity of illness correlates with mortality in critically ill elderly patients with NCSE. Treatment with intravenous benzodiazepines may increase their risk of death. Aggressive ICU management may prolong hospitalization at considerable cost, without improving outcome. It is unclear whether NCSE affects outcome in the critically ill elderly or is merely a marker for severity of disease in predisposed patients. The benefits of aggressive therapy are unclear. Carefully controlled, prospective trials will be necessary to determine the best therapies for NCSE in the critically ill elderly and the appropriate role of the ICU in their management.

KW - Critical illness

KW - Elderly

KW - Electroencephalography

KW - Nonconvulsive status epilepticus

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=0031791138&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031791138&partnerID=8YFLogxK

M3 - Article

C2 - 9821984

AN - SCOPUS:0031791138

VL - 39

SP - 1194

EP - 1202

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 11

ER -