Evaluation of Seizures in the Adult

Abstract

THE GENERALIZATION that every adult patient who develops a seizure disorder should have an air encephalogram is commonly accepted.* Yet the search for expanding intracranial lesions by this method is frequently disappointing, and the procedure is not without risk.Seizures may be an initial symptom in 20 to 35% of patients with intracranial tumor. On the other hand, among large groups of patients with seizure disorders the number of brain tumors demonstrable by air encephalography varied from 1%, in the younger patients, to 10%, in the older patients.7 Because of the serious implication of seizures developing in the adult, it is important that diagnostic methods be sufficiently accurate to indicate the presence or absence of intracranial mass lesions and that these methods be put in proper perspective with regard to their usefulness and benignancy.PRESENT INVESTIGATION All patients who have been admitted because of seizures to the Second (Cornell) Neurological Service, Bellevue Hospital, and the New York Hospital during the past 10 years have been reviewed to establish the usefulness and the place of diag¬ nostic methods employed in these institutions in evaluating the significance of seizures.The material for this study includes 245 patients whose seizures began after the age of 12 years. These patients were selected because a history of the illness was available, and physical and neurological examinations, skull x-rays, spinal fluid examinations, and encephalograms were made. Electroencephalograms were recorded on 215 of the group.One hundred ninety patients in this series had generalized seizures (Chart 1). In 106 patients the seizures started after the age of 35, and in 84 patients they started before the age of 35. Forty-eight patients had generalized seizures beginning after the age of 35 and had normal neurological examinations, skull x-rays, and spinal fluid examinations, and an electroencephalogram not suggesting brain tumor. None of this group of patients had intracranial mass lesions demonstrable by air encephalography. Thirty-six showed normal ventricular systems, and 12 had cortical atrophy. The same results, except for the lower incidence of cortical atrophy, were noted in a similar group of 43 patients whose seizures began before 35 years From the Second

A Follow-up Study of Late-onset Epilepsy--I. Neurological Findings

“…Marshall and Whitty (1952) found that in those patients who had their first fit between the ages of 20 and 40 the A.E.G. was of no further help if routine neurological examination was normal, and Martin (1954) expressed a similar view, although he qualified this by indicating that cortical atrophy may be shown by the A.E.G. These views do not coincide with our experience, since out of 31 A.E.G.s 23 were assessed as abnormal.…”

“…The first is that the condition is not rare. Thus in a study of 245 patients investigated for seizures after the age of 12 years Martin and McDowell (1954) found an incidence of 43% starting after the age of 35; and Alajouanine et al (1959), analysing 7,745 cases from the literature between 1901 and 1955, gives a figure of 32.7% in which epilepsy started after the age of 20. The second relates to the incidence of tumours.…”

A Follow-up Study of Late-onset Epilepsy--I. Neurological Findings

“…Marshall and Whitty (1952) found that in those patients who had their first fit between the ages of 20 and 40 the A.E.G. was of no further help if routine neurological examination was normal, and Martin (1954) expressed a similar view, although he qualified this by indicating that cortical atrophy may be shown by the A.E.G. These views do not coincide with our experience, since out of 31 A.E.G.s 23 were assessed as abnormal.…”

“…The first is that the condition is not rare. Thus in a study of 245 patients investigated for seizures after the age of 12 years Martin and McDowell (1954) found an incidence of 43% starting after the age of 35; and Alajouanine et al (1959), analysing 7,745 cases from the literature between 1901 and 1955, gives a figure of 32.7% in which epilepsy started after the age of 20. The second relates to the incidence of tumours.…”

A Follow-up Study of Late-onset Epilepsy--I. Neurological Findings

“…Marshall and Whitty (1952) found that in those patients who had their first fit between the ages of 20 and 40 the A.E.G. was of no further help if routine neurological examination was normal, and Martin (1954) expressed a similar view, although he qualified this by indicating that cortical atrophy may be shown by the A.E.G. These views do not coincide with our experience, since out of 31 A.E.G.s 23 were assessed as abnormal.…”

“…The first is that the condition is not rare. Thus in a study of 245 patients investigated for seizures after the age of 12 years Martin and McDowell (1954) found an incidence of 43% starting after the age of 35; and Alajouanine et al (1959), analysing 7,745 cases from the literature between 1901 and 1955, gives a figure of 32.7% in which epilepsy started after the age of 20. The second relates to the incidence of tumours.…”

A Follow-up Study of Late-onset Epilepsy--I. Neurological Findings

“…Marshall and Whitty (1952) found that in those patients who had their first fit between the ages of 20 and 40 the A.E.G. was of no further help if routine neurological examination was normal, and Martin (1954) expressed a similar view, although he qualified this by indicating that cortical atrophy may be shown by the A.E.G. These views do not coincide with our experience, since out of 31 A.E.G.s 23 were assessed as abnormal.…”

“…The first is that the condition is not rare. Thus in a study of 245 patients investigated for seizures after the age of 12 years Martin and McDowell (1954) found an incidence of 43% starting after the age of 35; and Alajouanine et al (1959), analysing 7,745 cases from the literature between 1901 and 1955, gives a figure of 32.7% in which epilepsy started after the age of 20. The second relates to the incidence of tumours.…”