Epilepsy in the elderly: life expectancy and causes of death

Abstract

All patients over the age of 60 who experienced seizures between 1979-83, were registered. The number of deaths was registered until July 2, 1985. Included were 162 patients who received no anti-epileptic drugs prior to the study period; 87 patients had established epilepsy at the time of admission. The number of deaths among previously untreated patients significantly exceeded expectation. Mortality was not significantly correlated to severity of epilepsy. In patients with brain tumor all but one died within the first year. Mortality among patients with postapoplectic seizures was significantly higher than expected being especially during the first year. Numbers of deaths among patients with seizures of unknown cause did not differ from the expected, neither did causes of death. Numbers of deaths in patients with established epilepsy at the time of admission was significantly higher than expected although none had malignant tumours and only 4 had postapoplectic seizures thus illustrating the influence of selecting patients with chronic active epilepsy. Eleven patients died suddenly and unexpectedly of unknown cause, which was more than expected. These patients were found dead under circumstances compatible with death occurring during seizure. Epilepsy was mentioned on the death certificate in only one case, indicating that the frequency of sudden, unexpected death among epileptics could easily be underestimated.

A Case of Lung Cancer with Brain Metastases Diagnosed After Epileptic Seizure

“…Lühdorf ve ark. [4] 60 yaş üzerinde ilk nöbetle başvuran 151 hastada yaptıkları çalışmada epileptik nöbetleri "geç epilepsiler" olarak isimlendirmişlerdir ve ilk kez ortaya çıkan nöbetin sebebinin olguların %32'sinde inme, %14'ünde metastazları da kapsayacak şekilde beyin tümörleri ve %25'inde ise tanımlanamayan nedenler olduğunu belirtilmiştir. Sundaram ve ark yaptığı çalışmada yaşlılarda nöbetin sebebi olarak vakaların %11-50'sinde kriptojenik, %22-39'sinde inme ve %2-22'sinde tümör gösterilmiştir [9].Bizim olgumuzun da 60 yaş üzeri ve ilk epileptik nöbet olması nedeniyle ayırıcı tanıda beyin tümörleri düşünüldü.…”

“…Bu semptomlardan biri olan epileptik nö-betlerin ilk belirti olarak görülme insidansı %20-35 arasındadır [3]. Özellikle ileri yaşlarda ortaya çıkan yeni başlangıçlı epileptik nöbetlerde serebrovasküler olaylardan sonra en sık metastatik beyin tümörlerine rastlanmaktadır [4]. Bu çalışmada biz, ilk defa epileptik nöbetle başvuran ve yapılan değerlendirmeler sonrasında beyin metastazı yapmış akciğer kanseri tanısı konulan bir olguyu sunmayı amaçladık.…”

The Mortality Associated with Epilepsy, with Particular Reference to Sudden Unexpected Death: A Review

“…The third tactic has been to follow a selected cohort for a defined length of time (16)(17)(18)(19)(20)(21)(22)(23)(24). Six other studies also provide an estimate of SUDEP rate for special groups or the general population, but because the estimates are uncertain these are not shown in the tables (25)(26)(27)(28)(29)(30). Each method has its own problems related to the accuracy and completeness of ascertainment of the numerator (deaths) or the denominator (total sample).…”

Epilepsie im Alter

“…Die Inzidenz einzelner unprovozierter Anfälle steigt noch rascher und erreicht 100 pro 100 000 mit 70 Jahren und 150-200 mit 80 Jahren [3]. Die Mortalität im Alter ist aber nicht von dem Vorhandensein oder der Schwere epileptischer Anfäl-le abhängig [72]. Da die kumulative Inzidenz mit dem Alter ansteigt, ohne dass die Mortalität zunimmt, nimmt die Anzahl der Erkrankten d. h. die Prävalenz im Alter zu und wird nach Daten aus den späten achtziger Jahren des letzten Jahrhunderts auf 1-1,5% geschätzt [45].…”