Status Epilepticus in the Elderly

SummaryStatus epilepticus is a life-threatening neurologic emergency. The elderly constitute the largest and fastest continuously growing population among patients with status epilepticus. The complexity of clinical presentations and difficulty in diagnosis further complicate, and possibly delay, prompt management. High clinical suspicion and proper investigation are the best tools for a prompt diagnosis. The etiology of elder-onset status epilepticus is primarily symptomatic, and cerebrovascular diseases are one of the most common causes, followed by neurodegenerative diseases such as dementia. Status epilepticus causes significant mortality among the elderly, who have the highest mortality of all age groups. These patients are very different from other age groups in many respects and clinicians should never treat them in the same manner as younger adults. Status epilepticus warrants immediate treatment to prevent irreversible neuronal damage. Decision-making regarding the choice of antiepileptic drugs (AEDs) depends on many factors such as adverse effect tolerability, drug interactions, and medical comorbidities. Balancing efficacy with the adverse effects of antiepileptic drugs is needed. The newer intravenous antiepileptic drugs, which have fewer adverse effects and drug interactions, appear to be reasonable treatment options for elderly patients. However, more evidence from clinical trials in this specific age group is required.