Abstract: We have read with great interest the excellent Review on delirium in elderly people by Sharon Inouye and colleagues (March 8, p 911).1Inouye SK Westendorp RG Saczynski JS Delirium in elderly people.Lancet. 2014; 383: 911-922Summary Full Text Full Text PDF PubMed Scopus (1808) Google Scholar We were surprised, however, by the lack of reference to epileptic disorders and non-convulsive status epilepticus in the pathophysiology and potential causes of delirium. Almost all risk factors presented (table 2,1Inouye SK Westendorp RG Saczynski JS Delirium in elderly people.Lancet. 2014; 383: 911-922Summary Full Text Full Text PDF PubMed Scopus (1808) Google Scholar risk factors for delirium from validated predictive models) are also classical risk factors for epilepsy. Delirium might be the manifestation of an ongoing seizure and can be protracted in case of lasting ictal activity.2Beyenburg S Elger CE Reuber M Acute confusion or altered mental state: consider nonconvulsive status epilepticus.Gerontology. 2007; 53: 388-396Crossref PubMed Scopus (27) Google Scholar, 3Sheth RD Drazkowski JF Sirven JI Gidal BE Hermann BP Protracted ictal confusion in elderly patients.Arch Neurol. 2006; 63: 529-532Crossref PubMed Scopus (61) Google Scholar Manifestations of non-convulsive status epilepticus can be subtle—with abnormal behaviour, mood changes, clouding of consciousness—reflecting almost all the criteria used to diagnose delirium in the confusion assessment method.Results from studies have shown that in all confounded causes of delirium in elderly people, epileptic discharges are commonly found and that non-convulsive status epilepticus is detected in 3–15% of patients.4Naeije G Bachir I Gaspard N Legros B Pepersack T Epileptic activities are common in older people with delirium.Geriatr Gerontol Int. 2014; 14: 447-451Crossref PubMed Scopus (15) Google Scholar Some studies report that epileptic discharges might play a part in the pathophysiology of delirium considering that treating patients with antiepileptic drugs improves delirium symptoms.5Kaplan PW Duckworth J Confusion and SIRPIDs regress with parenteral lorazepam.Epileptic Disord. 2011; 13: 291-294PubMed Google Scholar We did a prospective study, in which all elderly people with delirium had electroencephalographic monitoring for 24 h. Preliminary results, in more than 60 patients, show non-convulsive status epilepticus in 28% of elderly people with delirium. Such findings lead us to propose that epileptic activities might play an important part in elderly people delirium and that non-convulsive status epilepticus might explain a substantial proportion of delirium symptoms in many patients.We declare no competing interests. We have read with great interest the excellent Review on delirium in elderly people by Sharon Inouye and colleagues (March 8, p 911).1Inouye SK Westendorp RG Saczynski JS Delirium in elderly people.Lancet. 2014; 383: 911-922Summary Full Text Full Text PDF PubMed Scopus (1808) Google Scholar We were surprised, however, by the lack of reference to epileptic disorders and non-convulsive status epilepticus in the pathophysiology and potential causes of delirium. Almost all risk factors presented (table 2,1Inouye SK Westendorp RG Saczynski JS Delirium in elderly people.Lancet. 2014; 383: 911-922Summary Full Text Full Text PDF PubMed Scopus (1808) Google Scholar risk factors for delirium from validated predictive models) are also classical risk factors for epilepsy. Delirium might be the manifestation of an ongoing seizure and can be protracted in case of lasting ictal activity.2Beyenburg S Elger CE Reuber M Acute confusion or altered mental state: consider nonconvulsive status epilepticus.Gerontology. 2007; 53: 388-396Crossref PubMed Scopus (27) Google Scholar, 3Sheth RD Drazkowski JF Sirven JI Gidal BE Hermann BP Protracted ictal confusion in elderly patients.Arch Neurol. 2006; 63: 529-532Crossref PubMed Scopus (61) Google Scholar Manifestations of non-convulsive status epilepticus can be subtle—with abnormal behaviour, mood changes, clouding of consciousness—reflecting almost all the criteria used to diagnose delirium in the confusion assessment method. Results from studies have shown that in all confounded causes of delirium in elderly people, epileptic discharges are commonly found and that non-convulsive status epilepticus is detected in 3–15% of patients.4Naeije G Bachir I Gaspard N Legros B Pepersack T Epileptic activities are common in older people with delirium.Geriatr Gerontol Int. 2014; 14: 447-451Crossref PubMed Scopus (15) Google Scholar Some studies report that epileptic discharges might play a part in the pathophysiology of delirium considering that treating patients with antiepileptic drugs improves delirium symptoms.5Kaplan PW Duckworth J Confusion and SIRPIDs regress with parenteral lorazepam.Epileptic Disord. 2011; 13: 291-294PubMed Google Scholar We did a prospective study, in which all elderly people with delirium had electroencephalographic monitoring for 24 h. Preliminary results, in more than 60 patients, show non-convulsive status epilepticus in 28% of elderly people with delirium. Such findings lead us to propose that epileptic activities might play an important part in elderly people delirium and that non-convulsive status epilepticus might explain a substantial proportion of delirium symptoms in many patients. We declare no competing interests. Delirium in elderly peopleDelirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Full-Text PDF Delirium in elderly people – Authors'replyWe are pleased to clarify important aspects about our Review.1 Full-Text PDF
Publication Year: 2014
Publication Date: 2014-06-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 130
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