title: Nonconvulsive status epilepticus in a palliative care unit: when delirium is a seizure.
abstract: The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness. A concise review of NCSE follows, with emphasis on conditions that present similarly, precipitating factors, diagnostic and therapeutic considerations, and prognostic implications. Nonconvulsive status epilepticus is a reversible cause of altered consciousness, particularly when recognized promptly. In a palliative care unit, treatment should ultimately be guided by the patient's goals of care.
authors.affiliation: Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA samalar@ccf.org.
authors.forename: Renato V
authors.initials: RV
authors.lastname: Samala
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Armida
authors.initials: A
authors.lastname: Parala-Metz
authors.affiliation: The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D003693:Delirium / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D010166:Palliative Care; D012640:Seizures / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology
chemical_list: D000927:Anticonvulsants
keywords: altered mental status; nonconvulsive status epilepticus; palliative care