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Non-convulsive status epilepticus: a practical approach to diagnosis in confused older people
  1. Henry John Woodford1,
  2. James George2,
  3. Margaret Jackson3
  1. 1Department of Elderly Medicine, North Tyneside Hospital, Tyne and Wear, UK
  2. 2Department of Elderly Medicine, Cumberland Infirmary, Carlisle, UK
  3. 3Department of Neurology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  1. Correspondence to Dr Henry John Woodford, Department of Elderly Medicine, North Tyneside Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK; henry.woodford{at}


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.

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