title: Nonconvulsive status epilepticus in elderly a possible diagnostic pitfall.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Internal Medicine and Geriatric Department, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il
authors.forename: Linda
authors.initials: L
authors.lastname: Shavit
authors.forename: Tal
authors.initials: T
authors.lastname: Grenader
authors.forename: Ilia
authors.initials: I
authors.lastname: Galperin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000927:Anticonvulsants / Q000627:therapeutic use; D001519:Behavior; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003221:Confusion / Q000175:diagnosis / Q000453:epidemiology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000927:Anticonvulsants