Summary:Purpose: The aim of this study was to evaluate the clinical charactcristics of elderly patients wilh epilepsy.Methods; Wc retrospectively reviewed the clinical records of I90 patients ( 104 males and 86 females) aged 60 years or older at the time of study.Resu1t.r: Epilepsies were classified as generalized in 33 patients (17.4%), partial in 145 (76.3%), and undetcrmincd in 12 (6.3%). Twenty-nine of 33 patients with gencraliLed epilcpsy were idiopathic, whereas all patients with partial cpilepsy were symptomatic. Symptomatic partial epilepsy (SPE) began at all agcs (2 to 81 years). Patients with early onset ( i 20 ycars) showcd the most unfavorable course in both seizure control and soci:il adaptability. Paticnts with late onsct (50 years or older) had no family history of epilepsy, and half of them had a past history ofccrebrovascular disease or head injury as a presumed etiology. In paticnts with idiopathic gcneralized epilepsy (IGE), 25 of 29 had early onset, and a family history of epilepsy was found in 31%. Nineteen patients continued to have seizures aftcr SO years of age, albeit infrequently. Furthermore, 10 of them showed exacerbation around the age of 50.Conclusions: Most of the late onset cpilepsies were SPE with a rclativcly good prognosis. Gcneral belicf has held that seizure outcome in IGE is favorable, but some ICE paticnts show an increased seizure propensity in old age.

Twenty-four spontaneously occurring convulsive seizures were documented by closed-circuit TV (CCTV)-EEG monitoring in 3 cats subjected to unilateral amygdaloid overkindling for < or = 2 years. Electroclinical manifestations suggested that the seizures originated in the kindled amygdala (AM) (10 seizures in 3 cats), contralateral AM (7 seizures in 3 cats), or ipsilateral frontal cortex (7 seizures in 1 cat). All seizures of AM origin except one occurred during sleep 23 h to 20 days after the last stimulation-induced kindled seizure and culminated in secondarily generalized seizures. The seizures of frontal cortical origin occurred during waking within 1 h of a kindled seizure and remained partial in nature. In seizures of AM origin, ictal patterns at the primary and secondary sites were mirror images of each other, but latency of onset of each seizure stage in seizures of secondary site AM origin was longer than that in seizures of primary site AM origin in 2 of the 3 animals. We conclude that the secondary epileptogenic functional alterations capable of producing clinical seizures do occur in AM-overkindled cats, but the seizures are not entirely independent of the primary kindled site.

We surveyed pre- and postoperative levels of satisfaction with a range of the daily quality-of-life (QOL) domains in 132 sets of epilepsy surgery patients and their families. All patients underwent resective surgery for temporal lobe epilepsy and were monitored for > 2 years. Patient and family assessments showed patients' overall QOL markedly improves after surgery, depending on freedom from seizures. However, factors such as social contacts, family relations, or financial status improved little. Some families and patients were not satisfied with the postsurgical status, despite freedom from seizures. Patients who had surgery at a later age were not so satisfied with their postsurgical status as were patients who had surgery at a younger age, particularly on the QOL domains of role activities, memory function, leisure activities, or emotional well-being. This lower satisfaction level in older patients likely results from a variety of problems affecting patients during the long-lasting epileptic process; social handicaps, psychologic conflicts, and deterioration of cognitive/behavioral functions. Based on each case, we recommend that investigations start at an early stage of the illness, so that surgical intervention may be considered as early as possible.

In order to evaluate the quality‐of‐life (QOL) of epilepsy surgery patients, we surveyed patients' degree of life satisfaction and their families' degree of satisfaction with patient's status in a range of domains both pre‐ and post‐operatively. Of 100 patient‐family sets of surveys that were mailed out, 93 were completed and returned from patients and 91 from their families. All patients surveyed had temporal lobe epilepsy and had been followed for longer than 2 years after resective surgery. Patients and their families rated overall QOL as having markedly improved following surgery. However, they rated social domains of QOL, including role activities, financial status, and social and family relationships as having improved relatively little. Despite freedom from seizures, a few patients' families were dissatisfied with the patients' post‐operative status, primarily for psychosocial reasons. Patients operated on at a later age reported little gains in life satisfaction following surgery. This study supports the conclusion that surgical intervention should occur before patients are subjected to the psychological conflicts and social handicaps associated with chronic intractable epilepsy.

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