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

Abstract

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.

Characteristics and treatment outcomes of newly diagnosed epilepsy in older people: A 30‐year longitudinal cohort study

“…6 The EEG and brain imaging in older people reveal nonspecific findings more often than in younger patients with epilepsy. 19 Yield of interictal EEG in older patients with new-onset epilepsy is low (21%-37%), 20,21 an observation confirmed in our study (30.8%). In comparison, 52% had epileptiform abnormalities on their first EEG in a cohort of 441 children and young adults with incident epilepsy.…”

Diagnostic efficacy of dedicated MRI seizure protocol and standard protocol in evaluating seizures -A comparative study

“…Out of few studies done to know the seizures' gender predominance in our country, Hakimi et al, [10] in 2013, showed the ratio of M: F -61:39 where the results are close to this study result. Maher Arabi et al [11] found, in a total of 101 patients who were studied with history of seizure 57% were male and 43% of them were female, which is very similar to this study.…”

“…But in a study of 101 seizure patients, done by Maher Arabi et al[11], patients presented with a single episode seizure while 45 patients experienced more than one episode seizure.…”

Arterial Spin Labeling Magnetic Resonance Imaging in the Assessment of Non-Convulsive Status Epilepticus in Alzheimer’s Disease: A Report of Two Cases

“…These findings supporting a higher incidence of NCSE in the brain areas most vulnerable to the increased production of proteins associated with Alzheimer’s disease and with neurodegeneration [16]. Also, the involvement of previous cerebral ischemic infarction in Case 2 may have accelerated epileptogenic activities [12], although the relationship with Alzheimer’s disease-associated parietal areas remains unclear.…”

“…DWI showed slightly increased abnormal signal intensity around the right parietal cortex (Figure 2A, 2B). ASL showed hyperperfusion in the right inferior parietal lobe and precuneus area of the superior parietal lobe (Figure 2C, upper panel), which correlated well with hypoperfused brain areas associated with degenerative changes in Alzheimer’s disease [10], and cortical involvement by a small ischemic lesion as a cause of post-stroke epilepsy [12]. No remarkable findings were demonstrated by MRA (Figure 2D).…”