title: Nonconvulsive status epilepticus in palliative care patients.
abstract: Altered mental status and reduced level of consciousness are common among patients admitted to palliative care units. However, nonconvulsive status epilepticus (NCSE) has rarely been considered as a possible cause, and electroencephalographic confirmation of the epileptic status is sparse. The clinical presentation of patients with NCSE varies from altered mental status to coma, with no or only minimal convulsions. We report a prospective evaluation of patients with altered mental status on admission to our palliative care unit in the year 2007. Of 290 patients admitted in 2007, 49 patients showed signs of confusion or delirium and/or a reduction in their level of consciousness. NCSE was suspected clinically in 22 of these patients, and epileptic activity could be confirmed in 15 (5.2%) of 290 patients. Nine of 15 patients could be effectively treated with anticonvulsants and regained communication ability before death. NCSE appears to be an important, often unrecognized, and potentially treatable cause of altered mental status in palliative care patients. Pharmacological treatment might restore communicative abilities even in severely ill patients.
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: Berend
authors.initials: B
authors.lastname: Feddersen
authors.forename: Ralf
authors.initials: R
authors.lastname: Jox
authors.forename: Soheyl
authors.initials: S
authors.lastname: Noachtar
authors.forename: Gian Domenico
authors.initials: GD
authors.lastname: Borasio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D003693:Delirium / Q000150:complications / Q000523:psychology; D004351:Drug Resistance; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D020127:Recovery of Function; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants