Dados do Trabalho

Título

Rhythmic delta activity on initial EEG in elderly with nonconvulsive status epilepticus

Introdução

The EEG is essential for the diagnosis of nonconvulsive status epilepticus (NCSE). However, there are diverse and nonspecific patterns that can disappear with as the case evolves, which can make rapid diagnosis difficult.

Objetivo

To correlate the finding of rhythmic delta/theta activity (RDA) on the first EEG with clinical ictal phenomena in elderly patients with a diagnostic hypothesis of NCSE.

Método

Clinical aspects (time of onset, presence of automatisms, and changes in neurological and complementary exams) and EEG data (baseline activity, presence of spikes and sharp waves, and superimposed activity [modifiers- plus]) of 16 elderly patients treated at the Emergency Room of the PUC-Campinas University Hospital with altered level of consciousness and RDA on EEG.

Resultados

NCSE with coma was observed in 5 cases and focal NCSE with impaired consciousness in 11 cases. The elderly had a mean age of 75.4 years (66 – 86 years), from which 10 were women. All cases presented a clinical picture of cognitive impairment (4 cases), presence of automatisms(4 cases), and gaze-shifting eye movement (4 cases). The EEG showed a change with fluctuation in baseline activity in 14 cases. RDA was associated with focal electroclinical status epilepticus (SE) in 4 cases, lateralized periodic discharges (LPD) in 7 cases, and modifiers-plus in 6 cases (+F in 4 cases; +R in 2 cases). The etiologic diagnosis was metabolic alterations in 3 cases, brain lesions in 10 cases, and brain lesions associated with metabolic alterations in 3 cases. Epilepsy was diagnosed in 2 cases and a previous episode of SE in 4 cases. Six elderly people did not recover and died within 30 days of diagnosis.

Conclusão

RDA on EEG was frequent in elderly with NCSE and was associated with varying degrees of altered consciousness, different etiologies, and prognoses. RDA was associated with focal electroclinical SE and LPD, with no difference in prognosis, clinical presentation, and etiology.FAPESP2021/09899-2.

Palavras-chave

Non-convulsive status epilepticus, EEG, elderly