Protracted ictal confusion in elderly patients.
BACKGROUND
Ictal confusion, particularly if protracted, often presents a diagnostic challenge.


OBJECTIVE
To define protracted ictal confusion in elderly patients and to characterize its features and outcome.


METHODS
Case series.


METHODS
Neurology outpatient and emergency departments at 2 tertiary care centers.


METHODS
Consecutive series of 22 ambulatory patients with acute ictal confusion.


METHODS
Duration of ictal confusion was correlated with age and lesions noted on cerebral images and videoelectroencephalographic studies.


RESULTS
The ictal basis underlying confusion was not recognized for up to 5 days in 22 patients (mean +/- SD age, 70 +/- 8.5 years). Twenty patients had partial complex status epilepticus, and 2 patients had newly diagnosed primary generalized status epilepticus. Motor movements were not present in either group, although reduced mood states and ictal neglect were noted in some patients. Fifteen patients had previous episodes (2-10) of protracted ictal confusion. Once identified, treatment reversed confusion, and eventually patients were discharged to home, although a few patients sustained persistent reduction in baseline cognition.


CONCLUSIONS
Protracted ictal confusion is often not considered in the ambulatory elderly patient, with resulting delay in diagnosis. Electroencephalographic and videoelectroencephalographic studies performed while the patient is experiencing symptoms are crucial to early diagnosis and timely management.
Sheth
Raj D
RD
Department of Neurology, University of Wisconsin-Madison, 600 Highland Avenue, Box H6/574 CSC, Madison, WI 53792-5132, USA. sheth@neurology.wisc.edu
Drazkowski
Joseph F
JF
Sirven
Joseph I
JI
Gidal
Barry E
BE
Hermann
Bruce P
BP
D000367:Age Factors; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001284:Atrophy / Q000150:complications / Q000175:diagnosis; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease / Q000188:drug therapy; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D003221:Confusion / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D042241:Early Diagnosis; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000927:Anticonvulsants