Epilepsy in the elderly: prognosis

Lühdorf, K.; Jensen, Louise Kruse; Plesner, Anne‐Marie

doi:10.1111/j.1600-0404.1986.tb03534.x

Cited by 36 publications

(4 citation statements)

References 24 publications

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“…For the purpose of this study, we used the United Nations definition of elderly as patients aged 60 years or older ( 18 ) as was done in a number of previous studies ( 8 , 19 – 21 ).…”

Section: Methodsmentioning

confidence: 99%

Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures

et al. 2018

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Objective: To evaluate prospectively the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including dedicated epilepsy protocol MRI.Methods and materials: We included all consecutive patients 60 years or older who participated in a prospective study on new onset epilepsy. The work-up included the acquisition of a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We evaluated the frequency and types of epileptogenic lesions in the whole cohort and stratified those variables by age, gender, types and number of seizures at presentation. We also correlated the EEG findings with the clinical characteristics and neuroimaging results.Results: Of the 101 patients enrolled in the study and who underwent an epilepsy protocol MRI, an epileptogenic lesion was identified in 67% of cases. The most common etiologies were vascular events, followed by tumoral causes and traumatic brain injuries. Epileptogenic lesions were more likely to be identified in patients who presented with only focal aware and impaired awareness seizures. In addition, patients with tumoral epilepsy were significantly more likely to only experience those seizure types compared to patients with other pathological substrates. Interictal/ictal discharges were detected in the EEG of 21% of patients. Epileptiform discharges were significantly more frequent in patients with an epileptogenic lesion on brain MRI, especially in those with a brain tumor.Conclusions: Our results stress the importance of obtaining a dedicated epilepsy protocol MRI in elderly patients with new onset seizures. An epileptogenic lesion will be identified in approximately two thirds of patients with important implications regarding initiation of treatment. In addition, the data underscore the value of distinguishing the types of seizures experienced at presentation as this will apprise the treating physician on the likelihood of identifying an epileptogenic lesion and on the probable etiologies.

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“…For the purpose of this study, we used the United Nations definition of elderly as patients aged 60 years or older ( 18 ) as was done in a number of previous studies ( 8 , 19 – 21 ).…”

Section: Methodsmentioning

confidence: 99%

Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures

et al. 2018

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“…New epilepsy in the elderly commonly relates to CVD and decisions about treatment should take into account the frequent comorbidities and complex drug interactions in this age group (Krämer, ). Our findings are in keeping with the high remission of new and newly diagnosed focal epilepsies in patients with CVD (Mohanraj and Brodie, ) and in those over 60–65 (Lühdorf et al ., ; Stephen et al ., ), and suggest that modest doses of AEDs may suffice in such patients.…”

Section: Discussionmentioning

confidence: 98%

Epileptology of the first tonic‐clonic seizure in adults and prediction of seizure recurrence

Koutroumanidis

Bruno

2018

Epileptic Disorders

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Aims. The risk of seizure recurrence after a first unprovoked seizure is influenced by certain risk factors. To understand their effect in people with early diagnosed new epilepsy, we assessed the risk of recurrence of focal to bilateral tonic‐clonic or generalized tonic‐clonic seizures and the associated factors in a clinically well‐characterized cohort of adults with a first unprovoked tonic‐clonic seizure. Methods. We prospectively studied 150 consecutive adults with a first unprovoked tonic‐clonic seizure and full clinical, EEG, and brain imaging assessment within the first four weeks. New epilepsy was diagnosed and classified according to the International League Against Epilepsy criteria. Time to second focal to bilateral tonic‐clonic or generalized tonic‐clonic seizure was analysed using the Kaplan‐Meier method. Results. Early diagnosis of new epilepsy, including type or syndrome and aetiology, was possible in 109 patients (72.7%). The diagnostic yield of sleep‐deprived EEG was high in both genetic and non‐genetic localized focal epilepsies. A second focal to bilateral tonic‐clonic or generalized tonic‐clonic seizure occurred in 100 patients (66.7%) during a three‐year mean observation period. The risk was higher in non‐genetic focal epilepsies and lower in genetic epilepsies. Concurrent absences or myoclonic seizures and a first occurrence after awakening were predictors of a second generalized tonic‐clonic seizure in patients with genetic generalized epilepsy, while diagnosis of temporal or frontal lobe epilepsy, focal EEG discharges, and focal changes on brain imaging were related to an increased risk of focal to bilateral tonic‐clonic seizure recurrence, showing additive effects. Identifiable modulators or triggers for the first tonic‐clonic seizure, early treatment, and older age showed inverse association. Conclusions. The risk of a second generalized or focal to bilateral tonic‐clonic seizure and the factors involved vary across epilepsy aetiologies and syndromes. Early diagnosis and classification of new epilepsy is possible in most patients and may enable important adjustments to their management and treatment.

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“…Epilepsy is frequently seen in the elderly [18]. The annual incidence of epilepsy increases from 110/100,000 people between the ages of 65 and 69 to more than 160/100,000 in those over 80 years [10,[19][20][21]. In individuals aged 65 years or older, dementia and other neurodegenerative diseases account for 9-17% of the causes for epilepsies [10,18,[22][23][24][25][26][27].…”

Section: Epidemiologymentioning

confidence: 99%

Epilepsy in Elderly

Zhao¹,

Luo

2014

Brain Disord Ther

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Advanced technology and life science significantly prolongs human's lifespan. The prolonged longevity enables people to enjoy longer life but adversely increases the mortality and morbidity of aging-related disorders which may, in turn, devalue the quality of late life. Of the aging-related neurological conditions, increased incidence and prevalence of convulsive disorders, namely seizures or epilepsies, have been documented in literature. Epilepsy is the third most common neurological condition after dementia and stroke among the elderly. Multiple risk factors cause the elderly to be prone to develop seizures or epilepsies, including advanced aging, stroke, traumatic brain injury, dementia, neurodegenerative diseases, brain tumors, obstructive sleep apnea, and obesity. In this article, we highlight the epidemiology, pathophysiology, and clinical manifestations of elderly seizures.

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Epilepsy in the elderly: prognosis

Cited by 36 publications

References 24 publications

Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures

Frequency and Stratification of Epileptogenic Lesions in Elderly With New Onset Seizures

Epileptology of the first tonic‐clonic seizure in adults and prediction of seizure recurrence

Epilepsy in Elderly

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