Transient Ischemic Attacks and Inhibitory Seizures in Elderly Patients

Abstract

Background: The new definition of a transient ischemic attack (TIA) makes it more difficult to distinguish it from an inhibitory seizure (IS). Purpose: The present study compares the characteristics of patients with an IS to those with a TIA, taking into account the old and the new definition of a TIA. Patients and Methods: The clinical characteristics and the electroencephalogram (EEG) findings of 25 patients with an IS were compared to 252 patients with a TIA according to the old definition. Subgroups of 10 patients with an IS without structural lesions and 195 TIA patients according to the new definition were also analyzed. The differential diagnostic clues were examined. Results: Differences in age, gender distribution and vascular risk factors were observed only when comparing the overall patient groups. However, these differences disappeared when the subgroups were analyzed. Temporary speech disturbance, associated with some partial amnesia for the event, was the most common clinical presentation of an IS. Additionally, specific and nonspecific postictal EEG abnormalities were observed in the majority of the IS patients, while the EEG was normal in more than 90% of the TIA patients. Conclusions: An IS must be suspected in a patient with a short temporary speech disturbance and partial amnesia for the event. In view of the new definition of a TIA, urgent EEG becomes mandatory in each patient with a brief episode of neurological dysfunction.

Interictal spiking in adult newly-diagnosed focal epilepsy of unknown cause: The effect of age

“…Focal epilepsies of unknown cause, in which laboratory and neuroimaging findings are inconclusive, account for more than one third of cases of epilepsy in the elderly (Hauser et al, 1993;Ruggles et al, 2001). Moreover, the elderly show a higher incidence and prevalence of paroxysmal phenomena that can resemble epileptic seizures, as well as misleading seizure signs and symptoms that can complicate the differential diagnosis (Kellinghaus et al, 2004;De Reuck and Van Maele, 2009;Theodore, 2010;Werhahn, 2010).…”

“…The elderly are more likely than other age groups to present paroxysmal phenomena that masquerade as epileptic seizures, as well as clinical seizure features that can further complicate the differential diagnosis (Kellinghaus et al, 2004;De Reuck and Van Maele, 2009;Theodore, 2010;Werhahn, 2010). Moreover, the semiology and recurrence of epileptic seizures might be more difficult to ascertain in older patients.…”

Late-Onset Epilepsy and Occult Cerebrovascular Disease

“…3 The 'borderlands' of TIA, seizures, and other transient neurologic deficits have recently been expertly discussed 4 in relation to a retrospective study comparing the characteristics of patients with inhibitory seizures and TIA. 5 In particular, short, repeated episodes of speech disturbances-especially when accompanied by confusion or amnesia-were suggestive of inhibitory seizures. Several difficulties exist in clinical diagnosis.…”

Borderlands of Transient Ischemic Attacks, Seizures and other Transient Neurological Deficits

“…In issue 6 of European Neurology , de Reuck and van Maele [10] report a retrospective study which compares the characteristics of patients with inhibitory seizures and TIA, taking into account both the classical and the new definition of TIA. Retaining the new definition makes the differential diagnosis between the two conditions more difficult, but EEG abnormalities were still significantly different between the 2 groups.…”

“…Directions for future research include further investigation of how emerging biomarkers and gene expression profiles interact with clinical, electrophysiological and neuroimaging data [12] . Continued appraisal of clinical evaluation and complimentary examination strategies, such as by de Reuck and van Maele [10] , will help refine the diagnosis and treatment of patients with transient neurological disorders.…”