New onset geriatric epilepsy

Rowan, Alison; Ramsay, R. Eugene; Collins, Joseph F.; Pryor, Flavia M.; Boardman, Kathy D.; Uthman, Basim M.; Spitz, Mark C.; Frederick, Tim E.; Towne, Alan R.; Carter, Gregory S.; Marks, William J.; Felicetta, James V.; Tomyanovich, M. L.

doi:10.1212/01.wnl.0000167384.68207.3e

Cited by 473 publications

(355 citation statements)

References 20 publications

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“…Yeni tanı almış yaşlı hastalarda AEİ kullanımıyla ilgili yapılan bir araştırmada baş-langıç tedavisi olarak gabapentin ve lamotrijin önerilmek-tedir. [17] Başka bir araştırmada ise çocuklarda ve yaşlılarda parsiyel başlangıçlı epilepsilerde lamotrijinin karbamazepine göre daha iyi tolere edildiği bildirilmiştir. [18] Saetre ve ark.nın [19] bir çalışmasında ise karbamazepinle nöbetsizlik oranlarının daha yüksek olduğu, lamotrijinin ise daha iyi tolere edildiği gösterilmiştir.…”

Section: Discussionunclassified

Epilepsy in elderly patients

Halaç¹

2015

Epilepsi

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SummaryObjectives: The incidence of new-onset epilepsy is high among the elderly. This study presents the demographic characteristics, etiological factors, seizure types and response rates to treatment in a group of patients aged 65 years or over with delayed-onset epilepsy. Methods:The study comprised a retrospective evaluation of the records of 43 patients aged 65 or older with a diagnosis of delayed-onset epilepsy who were admitted to the epilepsy clinic in the Neurology Department of Bezmialem University Faculty of Medicine.Results: Patient mean age was 74.9 (66-92 years). Underlying disease was found to be cerebrovascular disease in 37.2%. Based on seizure type, 67.4% (n=29) patients had partial-onset and 32.6% (n=14) had generalized seizure. Treatment protocol in 93% (n=40) of the patients was monotherapy antiepileptic drugs, the most commonly used being levetiracetam (53.5%). Assessment of drug side effects showed no complaint in 86% (n=37) of the patients. During the three months prior to the study, 95.3% of the patients had been seizure free. Conclusion:The study found cerebrovascular disease to be the most common etiological factor in delayed-onset epilepsy. Partial-onset secondary generalized seizure was the most common seizure type. All patients responded well to monotherapy and have a good prognosis.Key words: Epilepsy; treatment; elderly patients. ÖzetAmaç: Yaşlılarda yeni başlangıçlı epilepsi insidansı oldukça yüksektir. Çalışmada, 65 yaş üstü geç başlangıçlı epilepsi tanısı alan hastaların demografik özellikleri, etiyolojik faktörleri, nöbet tipleri ve tedaviye yanıt oranları sunulmuştur ve literatür eşliğinde sonuçlar tartışılmıştır. Sonuç: Geç başlangıçlı epilepsi hastalarında en sık görülen etiyolojik neden serebrovasküler hastalık olup nöbet tipi çoğunlukla parsiyel başlangıçlı sekonder jeneralize tonik kloniktir, hastalar monoterapiye iyi yanıt verir ve prognoz iyi seyirlidir. Gereç ve

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Section: Discussionunclassified

Epilepsy in elderly patients

Halaç¹

2015

Epilepsi

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“…Many large‐scale double‐blind RCTs funded by nonprofit organizations fall within this category43, 44, 45, 46 and provide highly valuable evidence that can be applied to treatment decisions. The fact that a study was supported by a nonprofit organization, however, does not necessarily imply that it is unbiased or that it does not have weaknesses in terms of generalizability or external validity.…”

Section: Randomized Controlled Trialsmentioning

confidence: 99%

Not all that glitters is gold: A guide to the critical interpretation of drug trials in epilepsy

Perucca

Wiebe

2016

Epilepsia Open

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SummaryClinical trials represent the best source of evidence on which to base treatment decisions. For such evidence to be utilized meaningfully, however, it is essential that results are interpreted correctly. This requires a good understanding of strengths and weaknesses of the adopted design, the clinical relevance of the outcome measures, and the many factors that could affect such outcomes. As a general rule, uncontrolled studies tend to provide misleading evidence as a result of the impact of confounders such as regression to the mean, patient‐related bias, and observer bias. On the other hand, although randomized controlled trials (RCTs) are qualitatively superior, aspects of their execution may still decrease their validity. Bias and decreased validity in RCTs may occur by chance alone (for example, treatment groups may not necessarily be balanced for important variables despite randomization) or because of specific features of the trial design. In the case of industry‐driven studies, bias often influences the outcome in favor of the sponsor's product. Factors that need to be carefully scrutinized include (1) the purpose for which the trial is conducted; (2) potential bias due to unblinding or lack of blinding; (3) the appropriateness of the control group; (4) the power of the study in detecting clinically relevant differences; (5) the extent to which eligibility criteria could affect outcomes and be representative of routine clinical practice; (6) whether the treatments being compared are used optimally in terms of dosing, duration of treatment, and other variables; (7) the appropriateness of the statistical comparisons; (8) the clinical relevance of the outcome measures and whether all key outcome information is reported (for example, responder rates in completers); and (9) potential bias in the way results are presented and discussed. This article discusses each of these aspects and illustrates the discussion with examples taken from published antiepileptic drug trials.

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“…Randomize kontrollü sadece üç çalışma bu konuda yol göstericidir. [15][16][17] Bu yüzden yaşlı hastalarda tedavi kararları kişisel tecrübeye dayalıdır ve genel prensiplere bağlı kalınır. Mevcut çalışmalar lamotrijin ve gabapentinin tedavide karbamazepine göre üstün olduğunu gösterir, ama karbamazepinin yavaş titrasyonu ile bu fark kaybolabilir, ilaç etkinlikleri arasında bir fark bulunmamaktadır, sadece yeni nesil ilaçlar daha iyi tolere edilmektedir.…”

Section: Kaynaklarunclassified

Epilepsy profile in elderly patients

Mısırli¹,

Erdoğan²,

Tunali³

et al. 2014

Epilepsi

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SummaryObjectives: The incidence of epilepsy is high among elderly patients and rises up as the population gets older. The seizure semiology is different than the younger adults and difficult to recognize. In this study, we investigated the specialities of the epileptic seizures in the patients older than 65 years old. Methods: We analyzed retrospectively 196 patients who are older than 65 years old and were followed in the outpatient epilepsy clinic for at least two years. Results: In 196 patients, 80 had focal seizures, 102 had jeneralized seizures and 14 had undefined seizures. Post-stroke seizures in 112 patients were at the first line in etiology. Seizures were responsive to treatment as monotherapy in 148 patients and as politherapy in 48 patients. Conclusion: Instead of recognizing difficultly the seizures in the elderly, the treatment control is not hard and monotherapy is enough for many patients.Key words: Epilepsy; seizure type; treatment; elderly patients. ÖzetAmaç: Yaşlı hastalarda epilepsi insidansı nüfusun yaşlanmasıyla birlikte gittikçe artmaktadır. Genç erişkinlere göre nöbet semiyolojisi daha farklıdır ve nöbetlerin tanınması zordur. Bu çalışmada 65 yaş üzerindeki epilepsi nöbetlerinin özellikleri araştırıldı. Gereç ve Yöntem:Epilepsi polikliniğine başvuran ve yaşları 65 üstünde olan, en az iki yıldır izlenen 196 hasta geriye dönük olarak araştırıldı.Bulgular: Yüz doksan altı hastanın 80'i fokal, 102'si jeneralize, 14'ü belirlenemeyen tipte nöbeti vardı. Etiyolojide ilk sırayı 112 hasta ile inme sonrası nöbetler aldı. Yüz kırk sekiz hastada monoterapi, 48 hastada politerapi ile nöbetler kontrol altında idi. Sonuç:Yaşlı hastalarda nöbetler zor tanınmasına rağmen uygun tedavi ile kontrolleri zor değildir ve çoğu monoterapi ile iyi seyrederler.

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New onset geriatric epilepsy

Cited by 473 publications

References 20 publications

Epilepsy in elderly patients

Epilepsy in elderly patients

Not all that glitters is gold: A guide to the critical interpretation of drug trials in epilepsy

Epilepsy profile in elderly patients

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