Non-convulsive status epilepticus in elderly individuals: report of four representative cases*Presented in part as a poster at the Fifth Annual Meeting of the Sociedad Asturiana de Neurología, Oviedo, 17 May 2002.

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.