title: Non-convulsive status epilepticus: a practical approach to diagnosis in confused older people.
abstract: Non-convulsive status epilepticus (NCSE) presents with minimal seizure activity clinically, but with evidence on EEG. It is a recognised cause of delirium in older people, but prevalence estimates vary widely. As delirium is a common presentation in older people and because NCSE is potentially reversible, an improved diagnostic ability in this group could be highly beneficial. EEG testing is required to make a definitive diagnosis, but this may be difficult due to access to testing, patient adherence and result interpretation. NCSE has two commonly recognised forms: complex partial status epilepticus (CPSE) and absence status epilepticus (ASE). Clinical features associated with NCSE in older people presenting with confusion include a reduction in level of arousal; aphasia or interrupted speech; myoclonus or subtle jerking; staring; automatisms; perseveration or echolalia; increased tone; nystagmus or eye deviation; emotional lability; disinhibition and anosagnosia. Risk factors include female sex, a history of epilepsy or a tonic-clonic seizure around the time of onset, and recent discontinuation of benzodiazepines. A practical approach to the diagnosis of NCSE in older people is suggested based upon the presence of clinical features suggestive of NCSE and local access to EEG testing.
authors.affiliation: Department of Elderly Medicine, North Tyneside Hospital, Tyne and Wear, UK.
authors.forename: Henry John
authors.initials: HJ
authors.lastname: Woodford
authors.affiliation: Department of Elderly Medicine, Cumberland Infirmary, Carlisle, UK.
authors.forename: James
authors.initials: J
authors.lastname: George
authors.affiliation: Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Jackson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use*; D003221:Confusion; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D012737:Sex Factors; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000927:Anticonvulsants
keywords: ACCIDENT & EMERGENCY MEDICINE; GERIATRIC MEDICINE