Older patients with focal structural epilepsy at risk of postictal dysphagia

Older patients with focal structural epilepsy are more likely to experience swallowing problems after seizures, according to a study.

For the study, researchers used the local clinical database of all fibreoptic endoscopic evaluation of swallowing (FEES) examinations and identified patients with seizures, excluding those with intensive care unit admission or intubation >24 h and those receiving >0.5 defined daily doses of benzodiazepines or neuroleptics.

Medical records of patients were reviewed to identify pre-existing dysphagia or potential concurrent medical causes for dysphagia, such as hyponatremia, increased intracranial pressure, sepsis, or other encephalopathies associated with infections, or other possible causes at the time of admission.

The analysis included 41 patients (mean age, 79 years; female, 51.2 percent) who had dysphagia following a seizure, without evidence of any concurrent cause of swallowing dysfunction. All of them presented with focal structural epilepsy.

The mean Elixhauser Comorbidity Score was 4.8, and roughly half (51.2 percent) of the patients had hospital-acquired pneumonia.

Based on FEES examinations, dysphagia was mild in 21 patients (51.2 percent) and severe in 20 patients (48.8 percent). Dysphagia persisted for an average of 3.9 days (median 3 days) and significantly improved during hospitalization (p=0.001).

Additional research is needed to determine the prevalence, complications, and predictors of postictal dysphagia. Dysphagia screening should not only facilitate early detection in patients with relevant risk factors but also reduce the occurrence of aspiration pneumonia.