Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, Esasmus Hospital, Université Libre de Bruxelles, Belgium.
Geriatr Gerontol Int. 2014 Apr;14(2):447-51. doi: 10.1111/ggi.12128. Epub 2013 Aug 4.
Delirium is responsible for up to 56% of hospital admissions in the elderly. Epilepsy and delirium share most risk factors and are both associated with confusion. The aim of this work was to study whether a link between epileptic activity (EA) and delirium existed, and if this link was relevant.
Charts of patients aged over 65 years admitted for delirium at the emergency room in 2011 were retrospectively reviewed. Risk factors for delirium, past medical history, medications, biological and iconographic work-up were analyzed. Those characteristics were compared in patients who had electroencephalogram (EEG) with those who had not. Clinical characteristics of patients with EA on EEG were compared with the patients without EA.
A total of 177 charts were analyzed. The only parameters associated with the realization of an EEG were anti-epileptic drug treatment and subdural hematoma. A total of 56% (98/177) of patients had EEG. A total of 84% of EEG were abnormal. EA were present in 15% of EEG: 12 with interictal epileptiform discharges and three with non-convulsive status (NCSE). In multivariate analysis, only dehydration and the use of anticholinergic drugs were associated with EA. Outcome showed a trend for longer hospital stay and a higher institutionalization rate for patients with delirium who had EA.
EA occur in a significant proportion of delirium, and possibly have a role in the prognosis and pathophysiology of this disorder. Almost no anomalies can distinguish a priori patients in delirium who will have EA. EEG should be carried out in all older patients with delirium.
谵妄可导致高达 56%的老年人住院。癫痫和谵妄具有大多数共同的危险因素，且两者均与意识混乱有关。本研究旨在探讨癫痫活动（EA）与谵妄之间是否存在关联，以及这种关联是否具有临床意义。
回顾性分析了 2011 年因谵妄在急诊科住院的年龄在 65 岁以上的患者的病历。分析了谵妄的危险因素、既往病史、药物治疗、生物学和影像学检查。比较了进行脑电图（EEG）检查和未进行 EEG 检查患者的特征。比较了 EEG 上存在 EA 的患者与无 EA 的患者的临床特征。
共分析了 177 份病历。与进行 EEG 检查唯一相关的参数是抗癫痫药物治疗和硬膜下血肿。共有 177 例患者进行了 EEG 检查，其中 56%（98/177）患者的 EEG 结果异常。异常 EEG 占 84%，其中 EA 占 15%：12 例为发作间期癫痫样放电，3 例为非惊厥性癫痫持续状态（NCSE）。多变量分析显示，仅脱水和使用抗胆碱能药物与 EA 相关。结果表明，有 EA 的谵妄患者的住院时间更长，且更倾向于长期住院和机构化。
EA 发生在相当一部分谵妄患者中，可能在这种疾病的预后和病理生理学中发挥作用。几乎没有异常可以在出现谵妄之前区分出哪些患者会出现 EA。对于所有出现谵妄的老年患者，都应进行 EEG 检查。
