Non-convulsive status epilepticus in elderly individuals: report of four representative cases.

OBJECTIVE the purpose of this article is to describe the clinical and electroencephalographic features of four elderly patients diagnosed as having non-convulsive status epilepticus. METHODS four females ranging in age from 74 to 81 years were admitted to our hospital because of confusion and altered mental state. We recognised four distinctive entities: i) Absence status in a patient with pre-existing idiopathic generalised epilepsy; ii) De novo absence status of late onset precipitated by benzodiazepine withdrawal; iii) Complex partial status epilepticus in a patient with a focal brain lesion; iv) Subtle generalised status epilepticus in a comatose subject representing the final phase of convulsive status epilepticus. CONCLUSIONS the identification of non-convulsive status epilepticus may be particularly arduous in elderly subjects and, therefore, a high level of suspicion is essential to obtain an early diagnosis. An urgent electroencephalogram is considered as the method of choice in the diagnostic evaluation of non-convulsive status epilepticus. Finally, non-convulsive status epilepticus should be included among the causes of coma in older individuals.