title: Nonconvulsive status epilepticus in terminally ill patients-a diagnostic and therapeutic challenge.
abstract: Nonconvulsive status epilepticus (NCSE) is rarely considered as a cause of confusion in terminally ill patients. The clinical presentation varies from altered mental status to coma, without visible convulsions. Electroencephalogram is the most important diagnostic tool to identify epileptiform activity. Treatment should be initiated following a stepwise model, avoiding intubation and transfer to the intensive care unit. Although mortality rates are high, in some patients NCSE can be reversed by treatment. NCSE should be considered in a differential diagnosis of all terminally ill patients with sudden mental status changes. We present two cases and discuss treatment options and the borders of therapy.
authors.affiliation: Interdisciplinary Center for Palliative Medicine, Munich University Hospital, Munich, Germany. Stefan.Lorenzl@med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Lorenzl
authors.forename: Simon
authors.initials: S
authors.lastname: Mayer
authors.forename: Soheyl
authors.initials: S
authors.lastname: Noachtar
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Borasio
mesh_terms: D004829:Epilepsy, Generalized / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D013727:Terminal Care / Q000379:methods*