Toxic Ictal Confusion/Delirium

ABSTRACT

Diffuse repetitive EEG discharges usually indicate encephaopathies and nonconvulsive generalized status epilepticus. They rarely occur as an isolated confusional state in adult or elderly patients without an epileptic history. Ictal confusion occuring in 16 middle-aged nonepileptic patients and induced by drug withdrawal and toxic conditions is reported.

The electroclinical features and pathophysiological considerations underlying this syndrome are discussed along with a review of the pertinent literature. Immediate relief by I.V. benzodiazepines is emphasized. It is argued that this type of confusion represents an ictal state occuring in a nonepileptic subject; this condition should be regarded as a separate epileptic entity based on a multifactorial etiology. It is also suggested to classify the syndrome as a situation related nonconvulsive generalized status epilepticus.

KEY WORDS.:

• EEG-dysfunction
• ictal confusion/delirium
• multifactorial etiology
• nonconvulsive status epilepticus
• nonepileptic adult/elderly patients
• situation related syndrome