Dept of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Hôpital Erasme Université Libre de Bruxelles, Belgium.
Epilepsy Behav. 2012 Mar;23(3):330-4. doi: 10.1016/j.yebeh.2012.01.023. Epub 2012 Feb 29.
Acute confusional state (ACS) is a frequent cause of emergency consultation in the elderly. Many causes of ACS are also risk factors for seizures. Both non-convulsive seizures and status epilepticus can cause acute confusion. The yield of routine EEG may not be optimal in case of prolonged post-ictal confusion. We thus, sought to evaluate the yield of CEEG in identifying seizures in elderly patients with ACS of unknown origin.
We reviewed our CEEG database for patients over 75 years with ACS and collected EEG, CEEG and clinical information.
Thirty-one percent (15/48) of the CEEG performed in elderly patients were done for ACS. Routine EEG did not reveal any epileptic anomalies in 7/15 patients. Among those, CEEG identified interictal epileptiform discharges (IED) in 2 and NCSE in 1. In 8/15 patients, routine EEG revealed epileptiform abnormalities: 3 with IED (including 1 with periodic lateralized discharges), 3 with non-convulsive seizures (NCSz) and 2 with non-convulsive status epilepticus (NCSE). Among patients with only IED, CEEG revealed NCSz in 1 and NCSE in 2.
This retrospective study suggests that NCSz and NCSE may account for more cases of ACS than what was previously thought. A single negative routine EEG does not exclude this diagnosis. Continuous EEG (CEEG) monitoring is more revealing than routine EEG for the detection of NCSE and NCSz in confused elderly. The presence of IED in the first routine EEG strongly suggests concomitant NCSz or NCSE. Prospective studies are required to further determine the role of CEEG monitoring in the assessment of ACS in the elderly and to establish the incidence of NCSz and NCSE in this setting.
急性意识混乱状态（ACS）是老年人急诊咨询的常见原因。ACS 的许多病因也是癫痫发作的危险因素。非惊厥性发作和癫痫持续状态均可导致急性意识混乱。在发作后意识混乱时间较长的情况下，常规 EEG 的检出率可能不理想。因此，我们评估了连续脑电监测（CEEG）在识别原因不明的老年 ACS 患者癫痫发作中的作用。
我们回顾了我们的 75 岁以上 ACS 患者的 CEEG 数据库，并收集了 EEG、CEEG 和临床信息。
48 例患者中 31%（15/48）的 CEEG 是为 ACS 而进行的。7/15 例行常规 EEG 患者未发现任何癫痫异常。其中，2 例 CEEG 显示发作间期癫痫样放电（IED），1 例 CEEG 显示非惊厥性癫痫持续状态（NCSE）。在 15 例患者中，常规 EEG 显示癫痫样异常：3 例 IED（包括 1 例周期性偏侧放电），3 例非惊厥性发作（NCSz）和 2 例非惊厥性癫痫持续状态（NCSE）。仅 IED 的患者中，1 例 CEEG 显示 NCSz，2 例 CEEG 显示 NCSE。
这项回顾性研究表明，NCSz 和 NCSE 可能比之前认为的更能引起 ACS。单次常规 EEG 阴性不能排除该诊断。连续 EEG（CEEG）监测比常规 EEG 更能发现昏迷老年人中的 NCSE 和 NCSz。首次常规 EEG 出现 IED 强烈提示同时存在 NCSz 或 NCSE。需要前瞻性研究进一步确定 CEEG 监测在评估老年 ACS 中的作用，并确定在此情况下 NCSz 和 NCSE 的发生率。
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