Abstract
INTRODUCTION
Nonconvulsive status epilepticus (NCSE) is characterized by behavioral and vegetative abnormalities without classical major convulsive movements. A broad variability in clinical presentation makes this condition difficult to recognize and therefore NCSE is often overlooked especially in elderly.
AIM
To evaluate the prevalence, clinical features, therapeutic approach and outcomes of NCSE.
METHODS
This study represents prospectively collected data on patients accepted to the general geriatric ward with acute unexplained change in mental, cognitive, or behavioral status or confusion. Typical electroencephalogram (EEG) changes and significant improvement of these abnormalities and their mental status after administration of anticonvulsive therapy were required to establish the diagnosis of NCSE.
RESULTS
We identified 14 patients (average age 81 ± 7 years) with clinical and EEG changes consistent with NCSE. All patients suffered from significantly altered consciousness: 9 had acute confusion, 1 presented with coma and 4 with stupor. Eleven patients had diffuse and 3 temporal focal EEG abnormalities. All patients received anticonvulsants and had prompt and dramatic improvement in the EEG changes and in their mental status.
CONCLUSION
We conclude that high index of clinical suspicion along with typical EEG changes are the key tools to obtain diagnosis of NCSE. In our patients, significant mental impairment along with other adverse prognostic factors (advanced age, multiple comorbidities) pointed toward clear benefits from anticonvulsant therapy. Our experience highlights the importance of EEG in the evaluation of abrupt mental or behavioral changes in the elderly population as NCSE is difficult to diagnose but potentially treatable condition.
TY - JOUR
T1 - Nonconvulsive status epilepticus in elderly a possible diagnostic pitfall.
AU - Shavit,Linda,
AU - Grenader,Tal,
AU - Galperin,Ilia,
Y1 - 2012/08/11/
PY - 2012/01/24/received
PY - 2012/06/09/revised
PY - 2012/06/26/accepted
PY - 2012/8/14/entrez
PY - 2012/8/14/pubmed
PY - 2013/4/20/medline
SP - 701
EP - 4
JF - European journal of internal medicine
JO - Eur J Intern Med
VL - 23
IS - 8
N2 - INTRODUCTION: Nonconvulsive status epilepticus (NCSE) is characterized by behavioral and vegetative abnormalities without classical major convulsive movements. A broad variability in clinical presentation makes this condition difficult to recognize and therefore NCSE is often overlooked especially in elderly. AIM: To evaluate the prevalence, clinical features, therapeutic approach and outcomes of NCSE. METHODS: This study represents prospectively collected data on patients accepted to the general geriatric ward with acute unexplained change in mental, cognitive, or behavioral status or confusion. Typical electroencephalogram (EEG) changes and significant improvement of these abnormalities and their mental status after administration of anticonvulsive therapy were required to establish the diagnosis of NCSE. RESULTS: We identified 14 patients (average age 81 ± 7 years) with clinical and EEG changes consistent with NCSE. All patients suffered from significantly altered consciousness: 9 had acute confusion, 1 presented with coma and 4 with stupor. Eleven patients had diffuse and 3 temporal focal EEG abnormalities. All patients received anticonvulsants and had prompt and dramatic improvement in the EEG changes and in their mental status. CONCLUSION: We conclude that high index of clinical suspicion along with typical EEG changes are the key tools to obtain diagnosis of NCSE. In our patients, significant mental impairment along with other adverse prognostic factors (advanced age, multiple comorbidities) pointed toward clear benefits from anticonvulsant therapy. Our experience highlights the importance of EEG in the evaluation of abrupt mental or behavioral changes in the elderly population as NCSE is difficult to diagnose but potentially treatable condition.
SN - 1879-0828
UR - https://www.unboundmedicine.com/medline/citation/22884408/Nonconvulsive_status_epilepticus_in_elderly_a_possible_diagnostic_pitfall_
L2 - https://linkinghub.elsevier.com/retrieve/pii/S0953-6205(12)00173-2
DB - PRIME
DP - Unbound Medicine
ER -
