New onset seizures in Octogenarians

Abstract

Purpose: The occurrence of new seizure(s) in older adults is two- to three-fold higher as compared to the younger population, and previous studies have characterized the clinical features of seizures in patients beyond 60 or 65 years. This study, in response to the recent ILAE task force on epilepsy in the elderly (2023), has assessed the clinical characteristics of individuals who are over 85 years old.

Methods: Data was collected from prospectively maintained electronic medical records, and the participants were divided into seizure-free and seizure-recurrence groups, and their clinical characteristics were compared.

Results: Over a 30-year period, a single comprehensive epilepsy care center included a total of 40 patients, with a mean age of 88.7 ± 2.79 years - most common seizure type was generalized tonic-clonic seizures (45%), with a positive neuroimaging yield of 42.5% and an EEG showing specific abnormalities in 50% of cases. Etiology was unidentified in 50%, while stroke was the most common among identified etiologies (27.5%). Over a mean follow-up of 1.4 [0.2-5.8] years, monotherapy effectively controlled 62.5% of patients, but 47.5% experienced recurrence. When compared to the non-recurrence group, these patients showed significant risk factors such as a history of prior stroke [47.3% versus 23.8%, p = 0.031], use of phenytoin [68.4% versus 33.3%, p = 0.056], and clobazam [42.1% vs. 19%, p = 0.049].

Conclusion: This study contributes to better identification and improved characterization of late-onset seizures and adds that appropriate, timely management results in better outcomes.

Keywords: Clobazam; Idiopathic generalized epilepsy; Phenytoin; Seizure recurrence; > 85 years.