The role of electroencephalography in the early diagnosis of non-convulsive status epilepticus in elderly patients with acute confusional state: Two possible strategies?

Non-convulsive status epilepticus (NCSE) can pose considerable diagnostic challenges, especially in the elderly, because of the wide differential diagnosis with common underlying causes of acute confusional state in this age group. We reviewed the proposed electroencephalography (EEG) strategies to improve the diagnostic yield of non-convulsive status epilepticus in the elderly population. Specifically, a debated topic of clinical relevance is the exact role of the EEG in the early diagnosis of NCSE in the elderly. Two EEG strategies have been proposed to improve the diagnostic yield of NCSE: emergent abbreviated EEG (EAEEG) recordings with reduced montages, and continuous EEG (CEEG) monitoring. Both approaches appear to be potentially advantageous, but at the same time subject to intrinsic limitations. Our literature review found initial evidence that the diagnostic yield for NCSE of prolonged EEG recordings is superior to routine EEGs. Further research is needed to confirm these preliminary findings and to explore strategies to improve the feasibility of a more widespread use of prolonged recordings within acute clinical settings.