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Am J Hosp Palliat Care. 2015 Mar;32(2):243-7. doi: 10.1177/1049909113512719. Epub 2013 Nov 17.

Nonconvulsive status epilepticus in a palliative care unit: when delirium is a seizure.

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Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA.


The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness. A concise review of NCSE follows, with emphasis on conditions that present similarly, precipitating factors, diagnostic and therapeutic considerations, and prognostic implications. Nonconvulsive status epilepticus is a reversible cause of altered consciousness, particularly when recognized promptly. In a palliative care unit, treatment should ultimately be guided by the patient's goals of care.


altered mental status; nonconvulsive status epilepticus; palliative care

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