Exploring Status Epilepticus in the Elderly Population

In this article, we summarize an October 2018 review by I.E. Leppik that was published in the journal Epilepsia titled, “Status epilepticus in the elderly.”

Purpose

• Status epilepticus (SE) is a medical emergency that can affect people of all ages. However, people 60 years or more of age and children have a higher incidence of SE.
• SE can be defined as a seizure that lasts longer than 5 minutes or when seizures occur close together without recovery between them.
• There is a lack of information about SE in the elderly. Hence, in this review, Leppik outlines the incidence (how often), diagnosis, and treatment of SE in older adults.  

Background

• The elderly can have convulsive as well as non-convulsive SE. This review focused on convulsive SE because there is more information about this type of SE.
• Among people age 60 and older, the incidence of SE was found to increase with an increase in age.
• Studies have revealed the most common causes of SE in the elderly are stroke and traumatic brain injury. Additional causes of SE in this population are cancer and infection.

Treatment of SE in the Elderly  

• Given that SE is a medical emergency, treatment is urgently given to address symptoms at hand.
• Treatment of SE is done by anti-epileptic drugs (AEDs).
• Given the lack of knowledge of SE in older adults, treatment SE in the elderly is similar to those used in young adults.
  • Commonly used drugs include phenytoin, valproate, levetiracetam, and phenobarbital.
  • Unfortunately, there are not a lot of studies that look at how effective these drugs are in older adults.

Future Studies   

• Scientists are looking at whether SE is associated with mechanisms that are distinct from separate seizures.
• Epilepsy.com has reviewed the role of GABA receptors in SE. A target that researchers are pursuing for SE in the elderly is a specific GABAergic receptor modulator known as allopregnanolone.
• Leppik’s review also states that an ideal novel drug for SE in the elderly would have these characteristics:
  • The mechanism of action of the drug should the address mechanism of SE in the elderly.
  • There should be no interactions with drugs that the elderly are likely to take.
  • The drug should have a longer half-life, allowing for less-frequent dosing.
  • The drug should be safe to use in combination with other drugs that are routinely given to the elderly.

Citation

Leppik IE. Status epilepticus in the elderly. Epilepsia. 2018 Oct;59 Suppl 2:140-143.