Epilepsy in the elderly: restrictions, fears, and quality of life

May, Theodor W.; Pfäfflin, Margarete; Brandt, Christian; Füratsch, N.; Schmitz, Bettina; Wandschneider, Britta; Kretz, Rebekka; Runge, Uwe; Geithner, J.; Karakizlis, Hristos; Rosenow, Felix; Kerling, Frank; Stefan, Hermann

doi:10.1111/ane.12317

Cited by 18 publications

(26 citation statements)

References 23 publications

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“…One study compared the results of older adults with epilepsy to a matched healthy control group [21], three compared the results to the general epilepsy population from which their choice of questionnaire was standardised [22][23][24], four compared the results to younger age group(s) [25][26][27][28], and two studies had no comparison groups [29,30]. Two studies looked at if treatment affected QoL [29,30] [25,26,29]. One study classified their participants as 'older' based on their gender and retirement age, with women being > 60 years and men being > 65 years [27].…”

Section: Study Characteristicsmentioning

confidence: 99%

The quality of life of older adults with epilepsy: A systematic review

Baranowski

2018

Seizure

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The aim of this systematic review is to identify and synthesise the current literature on the quality of life (QoL) of older adults with epilepsy. Studies were included if they (1) assessed the QoL of older adults (2) had a minimum of one population group of people with epilepsy aged 60 and older and (3) used a standardised QoL measure. Databases searched were PubMed, Scopus, Cochrane Library and PubPsych. A total of 201 abstracts were screened, of which 10 articles met the criteria. A 17-item standardised checklist was used to analyse the methodological quality of the studies. This checklist was derived from other systematic reviews which analysed the QoL of those with other health conditions and modified to suit the purpose of this review. The findings were synthesised to compare the overall QoL of older adults in comparison to younger age groups and to identify which QoL factors were the most and least negatively impacted by the presence of epilepsy and old age. Predictors of QoL were identified from findings that used a regression analysis and were rated regarding their strength of evidence. No clear differences for overall QoL were found between older and younger people with epilepsy. Participants reported energy/fatigue to be the most negatively impacted factor. Seizure frequency was a strong predictor of QoL, and comorbidity and depression were moderate predictors. The modest number of studies available for synthesis is a reflection of the gap in current literature on this topic. Future research needs to include more variables within their regression analysis to identify more predictors of QoL, and needs to compare QoL changes over the trajectory of older age.

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Section: Study Characteristicsmentioning

confidence: 99%

The quality of life of older adults with epilepsy: A systematic review

Baranowski

2018

Seizure

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“…As in previous studies, inclusion of the persistent epilepsy patients with younger onset might demonstrate differences between the new-onset and persistent epilepsy in the elderly more clearly. 7,8 Our neglecting to analyze other important clinical features including ictal semiology, post-ictal symptoms, and psychosocial aspects was also another limitation. 7,8 However, we could not gather detailed clinical features in individual patients with the retrospective study design.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Our neglecting to analyze other important clinical features including ictal semiology, post-ictal symptoms, and psychosocial aspects was also another limitation. 7,8 However, we could not gather detailed clinical features in individual patients with the retrospective study design. Finally, although we attempted to include all patients, we admit that epilepsy and status epilepticus might have been under-diagnosed, especially when the patients were managed in departments other than neurology.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Only several studies compared clinical features of epilepsy in the elderly between the earlier and later onset groups with psychosocial considerations. 7,8 We hypothesized that elderly patients with persistent epilepsy may have different clinical features than those with new-onset disease, and we compared the characteristics of new-onset and persistent epilepsy in the elderly in various aspects, including the results of diagnostic evaluations, comorbidity, treatment, and prognosis.…”

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Comparison of new-onset and persistent epilepsy in the elderly

Kim

2019

Acta Neurol Scand

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Epidemiological studies show that the incidence of epilepsy is significantly higher in the elderly than in any other age groups, and the prevalence of epilepsy increases rapidly with age except in the very young population. 1 The high prevalence of epilepsy in the elderly may result from the more frequent epilepsy-associated neurological diseases such as stroke and traumatic brain injury, 2 but the improved survival of previously diagnosed epilepsy patients can affect the high prevalence in the elderly population because life expectancy did not decrease significantly in adult epilepsy patients with improvements in general medical care. 3 Although there have been a number of studies on elderly patients with epilepsy, most studies included only patients with new-onset disease and excluded patients who began to suffer from epilepsy before the age of 65 and aged. 4,5 Only several studies compared clinical features of epilepsy in the elderly between the earlier and later onset groups with psychosocial considerations. 7,8 We hypothesized that elderly patients with persistent epilepsy may have different clinical features than those with new-onset disease, and we compared the characteristics of new-onset and persistent epilepsy in the elderly in various aspects, including the results of diagnostic evaluations, comorbidity, treatment, and prognosis. AbstractBackground: Previous studies on elderly epilepsy included only patients with newonset disease, but there are many patients who developed epilepsy earlier and aged. Aim:We compared the characteristics of new-onset and persistent epilepsy in the elderly. Methods:We performed a 10-year retrospective analysis of elderly patients with epilepsy divided into two groups according to the onset of seizure: new-onset epilepsy (onset age ≥65) and persistent epilepsy (onset age<65). Results: Nearly half (78/172, 45.3%) of patients in the new-onset group presented as status epilepticus, and one-fourth of these (19/78, 24.4%) died during the initial treatment for status epilepticus. Patients in the new-onset epilepsy group presented more frequently as status epilepticus (59/153 vs 12/78, P < 0.001) and had a past history of status epilepticus (63/153 vs 20/78, P = 0.02). History of stroke (81/153 vs 30/78, P = 0.04), hypertension (83/153 vs 29/78, P = 0.01), and dyslipidemia (53/153 vs 17/78, P = 0.05) was more common in the new-onset group, but patients in the persistent group used more antiepileptic drugs (AEDs; P = 0.036) and total AED drug loads (P = 0.028). Conclusions:Our study shows that new-onset epilepsy has a higher incidence of status epilepticus and more stroke-related risk factors but may require fewer AEDs for epilepsy control. K E Y W O R D Selderly, epilepsy, status epilepticus in the new-onset group. Similar results were also observed in one previous study, 7 and differences in underlying pathological changes between the two groups could have affected this finding. 13 Patients in the new-onset epilepsy group had higher chances of stroke, hypertension, and dyslipidemi...

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“…Furthermore, clinical characteristics associated with specific age of seizure onsets can now be efficiently targeted, thus potentially improving overall patient health. This is integral for elderly patients with epilepsy, since they have been demonstrated to have a reduced quality of life compared to younger adults with epilepsy . Additional studies examining the disease course in older‐ or younger‐onset patients with clinical characteristics that differ from their peers are also justified.…”

Section: Discussionmentioning

confidence: 99%

Towards a clinically informed, data‐driven definition of elderly onset epilepsy

et al. 2015

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SUMMARYObjective: Elderly onset epilepsy represents a distinct subpopulation that has received considerable attention due to the unique features of the disease in this age group. Research into this particular patient group has been limited by a lack of a standardized definition and understanding of the attributes associated with elderly onset epilepsy. Methods: We used a prospective cohort database to examine differences in patients stratified according to age of onset. Linear support vector machine learning incorporating all significant variables was used to predict age of onset according to prespecified thresholds. Sensitivity and specificity were calculated and plotted in receiveroperating characteristic (ROC) space. Feature coefficients achieving an absolute value of 0.25 or greater were graphed by age of onset to define how they vary with time. Results: We identified 2,449 patients, of whom 149 (6%) had an age of seizure onset of 65 or older. Fourteen clinical variables had an absolute predictive value of at least 0.25 at some point over the age of epilepsy-onset spectrum. Area under the curve in ROC space was maximized between ages of onset of 65 and 70. Features identified through machine learning were frequently threshold specific and were similar, but not identical, to those revealed through simple univariable and multivariable comparisons. Significance: This study provides an empirical, clinically informed definition of "elderly onset epilepsy." If validated, an age threshold of 65-70 years can be used for future studies of elderly onset epilepsy and permits targeted interventions according to the patient's age of onset.

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Epilepsy in the elderly: restrictions, fears, and quality of life

Abstract: Seizure-related variables, tolerability of AEDs and comorbidity have a stronger impact on QoL and on restrictions due to epilepsy than age, age at onset of epilepsy or duration of epilepsy. However, some results indicate group-specific patterns of impairment and epilepsy-related fears.

Cited by 18 publications

References 23 publications

The quality of life of older adults with epilepsy: A systematic review

The quality of life of older adults with epilepsy: A systematic review

Comparison of new-onset and persistent epilepsy in the elderly

Towards a clinically informed, data‐driven definition of elderly onset epilepsy

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