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Protracted ictal confusion in elderly patients.
Raj D Sheth1, Joseph F Drazkowski, Joseph I Sirven
1Department of Neurology, University of Wisconsin-Madison, 600 Highland Avenue, Box H6/574 CSC, Madison, WI 53792-5132, USA. sheth@neurology.wisc.edu
Archives of Neurology
|April 12, 2006
Summary
Protracted ictal confusion in elderly patients is often misdiagnosed, delaying treatment. Prompt electroencephalography (EEG) and video-EEG are crucial for accurate diagnosis and management of this condition.
Area of Science:
- Neurology
- Geriatrics
- Epilepsy
Background:
- Protracted ictal confusion poses a diagnostic challenge, especially in elderly patients.
- Delayed recognition can lead to prolonged confusion and impact patient outcomes.
Purpose of the Study:
- To define protracted ictal confusion in elderly individuals.
- To characterize its clinical features and long-term outcomes.
Main Methods:
- A case series of 22 ambulatory elderly patients presenting with acute ictal confusion.
- Correlation of confusion duration with age, cerebral imaging, and videoelectroencephalographic (video-EEG) findings.
Main Results:
- Ictal confusion was unrecognized for up to 5 days in the majority of patients.
- Partial complex status epilepticus was the most common diagnosis, with some patients experiencing recurrent episodes.
- While treatment reversed confusion, some patients had persistent cognitive deficits.
Conclusions:
- Protracted ictal confusion is frequently overlooked in ambulatory elderly patients, leading to diagnostic delays.
- Electroencephalography (EEG) and video-EEG are essential for timely diagnosis and management.