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Non convulsive status epilepticus in the elderly.

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  • 1Epilepsy Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France, Rehabilitation Unit, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France, Centre de recherche de l'Institut du cerveau et de la moelle épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France, Université Paris Sorbonne, France.

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|March 28, 2019
PubMed
Summary

Non-convulsive status epilepticus (NCSE) is a common elderly condition, often presenting as confusion. Early EEG diagnosis and prompt benzodiazepine treatment are crucial for managing this serious neurological disorder.

Keywords:
EEGconfusionelderlynon convulsive status epilepticus

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Area of Science:

  • Neurology
  • Geriatrics
  • Epileptology

Background:

  • Non-convulsive status epilepticus (NCSE) is frequently observed in the elderly population.
  • It often manifests as prolonged focal seizures with impaired consciousness, sometimes termed complex partial status epilepticus.
  • A rarer form, de novo absence status epilepticus, can also occur.

Purpose of the Study:

  • To highlight the clinical presentation and diagnostic challenges of NCSE in the elderly.
  • To identify key risk factors associated with NCSE onset.
  • To outline current diagnostic and treatment strategies for NCSE.

Main Methods:

  • Review of clinical presentations and risk factors for NCSE in elderly patients.
  • Emphasis on electroencephalogram (EEG) findings, specifically the Salzburg EEG criteria, for diagnosis.
  • Description of treatment protocols, including first-line benzodiazepines and second-line antiepileptic drugs.

Main Results:

  • Identified risk factors include prior generalized tonic-clonic seizures, epilepsy history, female gender, and brain injury (e.g., stroke sequelae).
  • Confusional states of unknown origin in patients with risk factors warrant consideration of NCSE.
  • EEG is essential for diagnosis due to often non-specific clinical signs like stupor, confusion, or coma.

Conclusions:

  • NCSE in the elderly requires a high index of suspicion, especially when accompanied by risk factors and altered mental status.
  • Prompt diagnosis via EEG and timely treatment with benzodiazepines are critical.
  • The prognosis for NCSE is generally poor, with a significant mortality rate of approximately 30%.