Clinical features and prognosis of epilepsy in the elderly in western China

Huang, Cheng; Feng, Luzhao; Li, Yaohua; Wang, Ying; Chi, Xiaosa; Wang, Wei; Hao, Nanya; Zhou, Dong; Chen, Lei

doi:10.1016/j.seizure.2016.03.011

Cited by 24 publications

(29 citation statements)

References 26 publications

(33 reference statements)

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“…Four studies were identified that assessed the clinical characteristics of older people presenting with new-onset epilepsy [19][20][21][22]. The number of patients in each study ranged from 70 to 1848 (one study did not provide any details).…”

Section: Clinical Assessment and Prognosis Of New-onset Epilepsy In Older Peoplementioning

confidence: 99%

New‐onset epilepsy in the elderly

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Kwan

et al. 2018

Brit J Clinical Pharma

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People who are 60 years old and older have the highest incidence of developing new-onset epilepsy. The increase of the ageing population has resulted in a greater number of patients with new-onset epilepsy or at risk of developing the condition. Previously published review articles regarding epilepsy in older patients have had a broad focus, including people who were diagnosed with epilepsy in their childhood or middle age. The present review focuses on the causes, treatment, prognosis and psychosocial impact of new-onset epilepsy in people aged ≥60 years. Following a search of the medical electronic databases and relevant references, we identified 22 studies overall that met the inclusion criteria. Only four randomized clinical trials (RCTs) were identified that compared different antiepileptic drug treatments in this population, demonstrating that newer-generation antiepileptic drugs (e.g. lamotrigine and levetiracetam) were generally better tolerated. One uncontrolled study provided promising evidence of good outcomes and safety for surgical resection as a treatment for people with uncontrolled seizures. Five studies reported that people ≥60 years with new-onset epilepsy have significant cognitive impairments (e.g. memory loss) and psychological issues including depression, anxiety and fatigue. We found that there is limited evidence to guide treatment in people with Alzheimer's disease and epilepsy. The specific features of new-onset epilepsy in this target population significantly influences the choice of treatment. Cognitive and psychiatric screening before treatment may be useful for management. Two studies with proposed guidelines were identified but no formal clinical practice guidelines exist for this special population to assist with appropriate management. There is a need for more RCTs that investigate effective treatments with limited side effects. More research studies on the psychosocial effects of new-onset epilepsy, and long-term outcomes, for people aged ≥60 years are also required.

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Section: Clinical Assessment and Prognosis Of New-onset Epilepsy In Older Peoplementioning

confidence: 99%

New‐onset epilepsy in the elderly

Piccenna

Kwan

et al. 2018

Brit J Clinical Pharma

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“…Once the diagnosis of epilepsy in an older population has been made and appropriate treatment instituted, seizure‐freedom rate appears higher than in younger age groups, ranging from 83% to 92% 5,7,27,28 . Ninety‐four percent of the patients who achieved seizure freedom in our cohort did so on monotherapy, mostly on modest doses.…”

Section: Discussionmentioning

confidence: 81%

“…Once the diagnosis of epilepsy in an older population has been made and appropriate treatment instituted, seizure-freedom rate appears higher than in younger age groups, ranging from 83% to 92%. 5,7,27,28 Ninety-four percent of the patients who achieved seizure freedom in our cohort did so on monotherapy, mostly on modest doses. It has been postulated that this favorable treatment response may be reflective of possibly lower epileptogenicity of the common underlying causative lesions encountered in this age group as well as a lower likelihood of a genetic predisposition for recurrent seizures at play.…”

Section: Discussionmentioning

confidence: 88%

Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study

et al. 2020

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Objectives: To describe the clinical characteristics and evaluate the long-term treatment outcomes in older people with newly diagnosed epilepsy over the past 30 years. Methods: We included patients newly diagnosed with epilepsy and commenced on antiseizure medications (ASMs) at age 65 years or older between July 1982 and October 2012 at the Western infirmary in Glasgow, Scotland. They were followed up until April 2016 or death. Seizure freedom was defined as no seizure for at least 1 year on unchanged medication at the last follow-up. Results: A total of 201 patients (median age 73 years, 59% male) were included. The median duration from initial seizure to starting treatment was 8 months (interquartile range: 3.0-24.0 months); 42.2% (85/201) patients had more than five seizures before commencing treatment. Brain imaging showed potentially epileptogenic lesions in 19.7% (38/193) of patients and other abnormalities in 56.5% (109/193); 78.6% patients (158/201) were seizure-free at the last follow-up, of whom 94.9% were taking monotherapy. Concomitant aspirin use (n = 80) was associated with a lower probability of being seizure-free (relative risk 0.82, 95% confidence interval 0.70-0.97; P = .02). The use of second-generation ASMs as the initial monotherapy increased from 31.5% (23/73) before 2000 to 70.3% (90/128, P < .001) from 2000 onward. However, the seizure freedom rates (67.1% vs 55.5%; P = .35) and intolerable adverse-effect rates (16.4% vs 19.5%; P = .45) did not show any significant difference. Significance: There was often a long interval between seizure onset and the initiation of treatment in older people with new-onset epilepsy, although the majority responded well to ASM treatment. Brain imaging showed a high rate of abnormalities. Despite the increased use of second-generation ASMs, treatment outcomes in later-onset epilepsy have not improved over time. The possible effect of aspirin on treatment response warrants further investigation.

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“…The aetiologic features of epilepsy in elderly patients are quite different from the features in younger individuals [ 7 , 8 ]. Compared with the general population, stroke and dementia have been considered to more commonly play a role in the aetiology of epilepsy in elderly populations [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Aetiological Features of Elderly Patients with Newly Diagnosed Symptomatic Epilepsy in Western China

Guo

et al. 2018

BioMed Research International

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Aims Recent epidemiological studies have indicated that the incidence of epilepsy peaks after 60 years old, and epilepsy has become increasingly prevalent in elderly populations. The aim of this study is to identify the aetiologic characteristics of epilepsy in the elderly. Methods We retrospectively recruited elderly patients with newly diagnosed epilepsy identified in three epilepsy centres in western China; elderly patients were defined as individuals aged 60 years or older. Demographic characteristics, clinical epilepsy data, and the diagnosis and aetiology of epilepsy were recorded. Results A total of 760 patients with newly diagnosed epilepsy were enrolled in our study. Of these patients, 25% had experienced one or more episodes of status epilepticus, and 62.4% were confirmed as symptomatic. Among the symptomatic cohort, stroke and traumatic brain injury (TBI) were the two most common causes of epilepsy, followed by cerebral tumour, dementia, hippocampal sclerosis (HS), and central nervous system (CNS) infection. When analysed by residence and age, ischaemic stroke was the most common cause of epilepsy in urban patients, whereas traumatic brain injury was the leading cause of epilepsy in rural patients. Conclusion More than three-fifths of newly diagnosed epilepsy cases in elderly patients were confirmed as symptomatic, and stroke and traumatic brain injury were the primary aetiologies in elderly epileptic patients.

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Clinical features and prognosis of epilepsy in the elderly in western China

Abstract: In older people, late-onset epilepsies differed in several aspects from early-onset epilepsies. The overall effectiveness of AEDs treatment in older people was satisfactory.

Cited by 24 publications

References 26 publications

New‐onset epilepsy in the elderly

New‐onset epilepsy in the elderly

Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study

Aetiological Features of Elderly Patients with Newly Diagnosed Symptomatic Epilepsy in Western China

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