Epilepsy with onset at over 50 years of age: clinical and electroencephalographic characteristics

Abstract

The elevated incidence of epilepsy with onsetat over 50 years of age, in relation to the total number of new cases of epilepsy, has been ignored in the literature in recent decades 1 . Studies have shown that epilepsy affects approximately 1 to 2% of the elderly population, and the incidence increases progressively with the advance in age. These cases of epilepsy can occur due to an acute cerebral seizure or have no apparent precipitator 2,3 . On the other hand, there is consensus in the literature that epileptic seizures (ES) are more difficult to diagnose in the elderly for various reasons such as the difficulty in obtaining an accurate clinical history, a frequently atypical ictal presentation, difficulty in making a differential diagnosis between an epileptic and non-epileptic event [3][4][5][6] and due the occurrence of comorbidities 5,6 . Although epilepsy is considered to be one of the commonest neurological affections in the elderly, and despite the need to take public health measures due to the progressive increase in the elderly population, particularly in developing countries, no national (Brazilian) publications and only a few international ones on epilepsy in this age range were found.Thus, the objective of the present study was to evaluate the clinical and electroencephalographic aspects of ES and epilepsies in patients with late-onset ES at over 50 years of age, also considering different age ranges. METHODS PatientsFifty-five patients, consecutively attended at the neurological clinic of the Celso Pierro Hospital and Maternity ABSTRACTEpilepsy in older individuals has an elevated incidence. The objective of the present work was to evaluate the clinical, EEG and brain imaging aspects in patients showing late-onset epilepsy. Fifty-five patients with late-onset epilepsy (older than 50 years) were evaluated. They were composed of two groups according to the onset age of the epilepsy seizure (ES): 51-60 (G51-60) and over 60 (G60+) years. Focal ES predominated although they were less frequent in G60+. The occurrence of status epilepticus was high and more frequent in G60+ whereas seizures in series predominated in G51-60. Symptomatic epilepsy was more frequent and the vascular etiology predominated. Epileptiform activity was associated with a greater number of ES, and background activity abnormalities were more frequent in G60+. In conclusion, epilepsy with onset at over 50 was predominantly focal and symptomatic, with a high occurrence of status epilepticus and of seizures in series.Key words: epilepsy, aged, epileptic seizures, electroencephalography. RESUMOEpilepsia no idoso tem elevada incidência e peculiaridades pouco estudadas. O objetivo do presente trabalho foi avaliar aspectos clínicos e eletrencefalográficos de pacientes que apresentaram a primeira crise epiléptica (CE) tardiamente. Foram avaliados 55 pacientes com epilepsia tardia (com início após os 50 anos), divididos em dois grupos segundo a idade de início das CE: de 51-60 anos (G51-60) e após os 60 anos (G60+). Predominaram as CE focai...

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“…Most epilepsy in childhood or adolescence onset is generalized genetic epilepsies with generalized tonic‐clonic seizures or absences 44,45 . Moreover, for late‐onset epilepsy, with onset after age 50, symptomatic epilepsy occurs more frequently, with a predominance of vascular etiology with focal seizures 46 . In addition, psychophysiological differences have shown that women are more prone to anxiety than men 47 .…”

“…44,45 Moreover, for late-onset epilepsy, with onset after age 50, symptomatic epilepsy occurs more frequently, with a predominance of vascular etiology with focal seizures. 46 In addition, psychophysiological differences have shown that women are more prone to anxiety than men. 47 Generalized epilepsy and absence seizures are characterized by a loss of consciousness during the seizures and the patient's inability to recognize what is happening during the epileptic seizures.…”

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“…al, 2012) Focal sharp waves are (in the case of epileptiform) the interictal marker of a patient with epilepsy and are the EEG signature of a seizure focus. (Tedrus et al, 2012) 23 Superior temporal gyrus has is a crucial structure making auditory processing possible. It is rapidly involved in function of language in patients who evince to have impaired vocabulary.…”

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