Differences in the management of epileptic seizures between the elderly and younger adults treated in an emergency department

作者：Fernandez Alonso Cesareo; Matias Guiu Jordi A; Castillo Carlos; Fuentes Ferrer Manuel E; Gonzalez Del Castillo Juan; Javier Martin Sanchez F

来源：Revista de Neurologia, 2014, 59(6): 241-248.

• Elderly
• Emergency department
• Epilepsy
• Epileptic seizures
• Hospital resources

Aim. To study the differences in the management and short-term outcomes of adult patients treated in an emergency service for epileptic seizures, depending on whether they are elderly or not.
Patients and methods. This observational retrospective cohort study included all the patients over 15 years of age who were treated for epileptic seizures in the hospital emergency department of a tertiary and university hospital between 1 September and 31 December 2011. The variables collected were acute treatment and follow-up at 30 days after the index event in the emergency department.
Results. Altogether the sample included 114 patients with a mean age of 46.4 years (interquartile range: 32.6-74.3 years), of whom 34 (29.8%) were aged 65 years or over. The group of elderly persons presented a first epileptic episode (p = 0.001), with unknown precipitating factor (p = 0.02), structural causation (p < 0.001), a computerised tomography scan carried out in the emergency department (p < 0.001), establishment of preventive antiepileptic drug regime in the emergency department (p = 0.001) and a prolonged hospital stay (p = 0.002) more frequently than the younger adults. Following a multivariable analysis, being elderly was an independent factor associated to a greater need for specific complementary tests (odds ratio = 3.7; 95% confidence interval = 1.3-10.3) and pharmacological intervention in the emergency department (odds ratio = 3.3; 95% confidence interval = 1.4-8.1). There were no statistically significant differences in the results between the two groups at 30 days in terms of return visits (p = 0.316) and mortality (p = 0.087).
Conclusions. The treatment of epileptic seizures in the elderly in the emergency department is complex, if compared with younger adults, thereby making it necessary to use a greater amount of hospital resources.

• 出版日期2014-9-16