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Lookup NU author(s): Dr James George, Dr Margaret Jackson
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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.
Author(s): Woodford HJ, George J, Jackson M
Publication type: Review
Publication status: Published
Journal: Postgraduate Medical Journal
Year: 2015
Volume: 91
Issue: 1081
Pages: 655-661
Print publication date: 01/11/2015
Online publication date: 23/09/2015
Acceptance date: 30/08/2015
ISSN (print): 0032-5473
ISSN (electronic): 1469-0756
Publisher: BMJ PUBLISHING GROUP
URL: http://dx.doi.org/10.1136/postgradmedj-2015-133537
DOI: 10.1136/postgradmedj-2015-133537
