Seizures and epilepsy in elderly patients of an urban area of Iran: clinical manifestation, differential diagnosis, etiology, and epilepsy subtypes

Abstract

The incidences of seizures and epilepsy in the population show a peak after 60 years of age. Due to the lack of reported clinical aspects of seizure and epilepsy in the older patients in our region in Iran, this study was conducted to describe the clinical manifestation, etiology, differential diagnosis, and epilepsy subtypes of epilepsy and seizure. A cross-sectional retrospective study was performed on all consecutively elderly seizure and epilepsy patients, referred to the Epilepsy Association in the city of Qom, Iran over a 10-year period. A total of 466 patients aged >60 years were admitted. 31 % of the patients had epilepsy or seizure and 69 % of them had non-epileptic events. The most prevalent differential diagnoses in the beginning were syncope and cardiovascular disorders. The most frequent clinical symptom of epilepsy was generalized tonic-clonic seizures (75 %). The most common cause of seizure was systemic metabolic disorder (27 %). In epileptic elderly patients, no cause was ascertained for 38 % and the most frequently observed pathological factors were cerebrovascular diseases, which accounted for 24 %. The most common type of epileptic seizure was generalized epileptic seizures (75 %). 10 % of elderly epileptic patients suffered from status epilepticus, which was primarily caused by anoxia. Despite the rising rate and potentially profound physical and psychosocial effects of seizures and epilepsy, these disorders have received surprisingly little research focus and attention in Iran. Referring older patients to a specialist or a specialist epilepsy center allows speedy assessment, appropriate investigation and treatment, and less likely to miss the diagnosis.

Clinical features and prognosis of epilepsy in the elderly in western China

“…Some studies have, however, reported that 75% of older people with epilepsy had generalized seizures [10] while another study found no differences [11]. It is likely that the high occurrence of cerebral pathology in older people is responsible for the predominance of focal-onset epilepsy in our group.…”

The Causes of Secondary Epilepsy in Epileptic Patients Referred to Neurology Clinics of Mashhad Hospitals

“…In other similar studies, patients' average age was not specified or the subjects were within a limited age range. For instance, Tabatabaei et al performed a study on patients above 60 years over ten years (15).…”

“…The most common differential diagnoses were syncope and cardiovascular disorders. In addition, 27% and 24% had systemic metabolic disorders and cerebrovascular diseases, respectively (15).…”

Epilepsy profile in elderly patients

“…İran'da 2013'te yapılan bir çalışmada da jeneralize nöbet oranları %75 gibi yüksek bulunmuştur. [3] Hasta grubumuzda nöbetlerin 21 tanesi atipik bulgularla presente idi ve sıkı takip sonucu ve EEG bulguları yardımıyla kesin tanıya ulaşıldı.…”

“…[1,2] Yaşlı hastalarda epilepsiler etiyolojik faktörler açısından da genç hastalardan daha farklıdır ve yaşlılarda eşlik eden hastalıklar nedeniyle farmakolojik etkileşimler de önemlidir. [3,4] Bu çalışmada, kliniğimiz epilepsi polikliniğinde takip edilen epilepsi hastaları içinde yaşları 65 üzerinde olanlar çalışma-ya alındı ve nöbet tipi, etiyoloji, tedavi ve prognoz açısından incelendi.…”