New-Onset Geriatric Epilepsy in China

Abstract

Background:Few studies have been published on new-onset geriatric epilepsy especially in older Chinese people. This study was to have a comprehensive understanding of new-onset geriatric epilepsy and find a more reasonable diagnosis and management of epilepsy in older people.Methods:One hundred and three patients with onset age 60 years and older were admitted between January 2008 and December 2016. Electronic medical records were reviewed to collect information.Results:There were 103 older patients with new-onset epilepsy. The mean age of the patients was 68.5 ± 6.4 years (range: 60–89 years), and there were 67 (65%) men and 36 (35%) women. The mean onset age was 67.9 ± 6.2 years (range: 60–89 years). The most common identifiable etiology of symptomatic seizures was autoimmune epilepsy in 43 (41.7%) patients. The second most common etiology was stroke in 15 (14.6%) patients. Seven (6.8%) older patients with acute seizures present with status epilepticus and 26 (25.2%) patients experienced clustered seizures (more than three events in 24 h) at seizure onset. Focal seizures (96.1%) were more common than generalized seizures (3.9%). Fifty-three (51.5%) patients had an abnormal brain magnetic resonance imaging (MRI) scan. Among them, video-electroencephalogram findings in 31 (30.1%) patients correlated with MRI abnormalities. Levetiracetam was the most used drugs before admission, in hospital, and during follow-up.Conclusions:Autoimmune encephalitis is becoming an increasing risk factor of subsequent epilepsy in older people. Older patients with new epilepsy are more likely to respond to antiepileptic drugs, and drug-resistant epilepsy is uncommon.

Seizures in autoimmune encephalitis: Kindling the fire

“…In one Chinese cohort of 103 patients with geriatric new onset epilepsy (onset at age > 60 years), the most common cause was autoimmune (41.7%). 14 A similar theme is seen in new onset refractory SE (NORSE), in which autoimmune mechanisms such as AIE are believed to be the most common cause. 15,16…”

Seizures in autoimmune encephalitis: Findings from an EEG pooled analysis

“…In addition, both systemic and CNS inflammation can precipitate epileptic seizures [12]. In such intricate scenario, AEs have recently provided a peculiar model of seizures related to aberrant adaptive immunity [14], and are supposed to account for a large proportion (reportedly, up to 40%) of late-onset epilepsy cases [15].…”

Clinical and Etiological Characteristics of Epilepsy in the Elderly: A Hospital-Based Study from a Tertiary Care Referral Center of Niamey, Niger

“…This predominance of focal-onset seizures has been reported previously in several studies. 4,6,10,11 However, Kuate-Tegueu et al 5 reported as far as they are concerned in Cameroon a predominance of generalized tonic-clonic seizures (44%).The high prevalence of focal brain lesions in the elderly explains this predominance of focal-onset seizures in these persons.…”

“…Maiga et al 4 in their study reported a proportion of epilepsies without a defined etiology of 18%, but these authors do not specify if the workup was complete or no in their patients. Chen et al 10 reported as far as they are concerned autoimmune encephalitis as the most common identified causes followed by cerebrovascular disease. The same authors report a proportion of epilepsies without a defined etiology of 21.4%.…”

“…Similar results have been reported in previous studies in sub-Saharan Africa on epilepsy in the elderly. 4,5 However, Chen et al 10 reported, as far as they are concerned, the preferential prescription of newer generation AEDs (levetiracetam and oxcarbazepine). Newer generation AEDs are not only inaccessible in Niger, but also they are expensive for patients, which the majority of them do not have a source of monthly income.…”