QUEER TURNS

Also referred to as "spells", "altered mental states", "funny turns",

Nonconvulsive status epilepticus (NCSE) is an underrecognized condition in the elderly.
Patients with NCSE often have impaired consciousness but do not show classic ictal or convulsive motor findings;
an electroencephalogram (EEG) is required for diagnosis and management. Frequently, NCSE occurs in the setting
of acute medical conditions. In a recent retrospective analysis of 1048 patients with “spells” or altered mental
status, 7% were found to have NCSE, and another 13% demonstrated epileptiform discharges.

Defined as an ongoing state of seizures, or multiple seizures without convulsions, and without return to baseline for at least 30 minutes,1 the clinical features of NCSE are highly variable. They include cognitive impairment, speech arrest, subtle facial, trunk, or limb twitches, head or eye deviation, autonomic signs (like unilateral mydriasis, paroxysmal hypertension, or arrhythmias), automatisms, and bizarre behaviors including wandering, hallucinations, fear, and ecstasy. These features can challenge diagnosis, as such symptoms may arise from other conditions. NCSE diagnosis is confirmed by EEG demonstration of ongoing ictal activity.1

Sutter R, Rüegg S, Kaplan PW. Epidemiology, diagnosis, and management of nonconvulsive status epilepticus: Opening Pandora's box. Neurol Clin Pract. 2012 Dec;2(4):275-286. doi: 10.1212/CPJ.0b013e318278be75. PMID: 30123679; PMCID: PMC5829470.

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