Seizures and Epilepsy in the Elderly

Thomas, Robert J.

doi:10.1001/archinte.1997.00440270035003

Cited by 91 publications

(43 citation statements)

References 175 publications

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“…24 Another study by Christine et al, found cortical infarcts in 20% cases followed by tumor (10%), cryptic arteriovenous malformation (4%) and mesiotemporal sclerosis (2%). 26 In our study, CT brain was abnormal in 95 (61.7%) patients and 61 (59.7%) patients had abnormal MRI brain. This finding of neuroimaging was due to selection of patients for MRI brain study.…”

Section: Discussionsupporting

confidence: 48%

Seizures and Epilepsy in Elderly: A Tertiary Care Centre Hospital Based Study

Sarmah¹,

Kharbanda²,

Prabhakar³

2015

jemds

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Seizure and epilepsy in elderly compared with younger adult population, differs in etiology, clinical presentation and prognosis. Management of epilepsy in elderly individual can be complicated by various factors, like concurrent medical illnesses, drug interactions, changes in pharmacokinetics and altered central nervous system pharmacodynamics. Adverse effects of antiepileptic drugs are also high in elderly people. METHODS: One hundred and fifty-four patients with seizures and epilepsies and age more than 60 years were included in the study. All enrolled patients underwent detailed clinical history, laboratory investigations and imaging studies. Classification of seizure was done as per ILAE classification 1981ILAE classification /1989. RESULTS: A total of 154 patients aged 60 or more were included in the study, out of which 102 (66.2%) males and 52 (33.76%) females. One hundred and eight (70.1%) patients started having seizures after 60 years of age and remaining patients (29.9%) had seizure onset before 60 years. Symptomatic epilepsies were the most common type of epilepsy (78.6%) and partial seizures were the most common type of seizure in the study (51.9%). Cerebrovascular diseases were the most common cause of seizures and epilepsies in elderly (44.8%) followed by CNS infections (11.7%), metabolic factors (7.8%), brain tumors (6.5%), head injury (6.5%) and hippocampal sclerosis (4.6%). EEGs were abnormal in 34.9% patients, whereas CT brain (n=154) and MRI brain (n=102) were abnormal in 61.7% and 59.7% respectively. Majority of patients had received only one AED at the time of inclusion (59.1%) in the study. Phenytoin was the most common antiepileptic that was used for the treatment of seizures (74.7%). Overall incidence of AED induced adverse effects was 22.1%. Most common adverse effect was drowsiness (13.6%) followed by decrease memory (5.2%) and tremor (3.2%). Incidence of adverse reactions was highest among phenobarbitone treated group (33.3%). HOW TO CITE THIS ARTICLE: INTRODUCTION:Seizures occur in an age dependent, bimodal pattern with an initial peak in incidence during the first year of life and then a sustained rise in incidence beginning around the age of 60 years that surpasses incidence at all other ages. 1-3 As people are surviving longer, the average age of the population further rises increasing the number of elderly individuals at risk for developing seizures and epilepsy. 4 Studies have shown approximately 1-2% of the aging population has epilepsy. 5 At age over 75 years, it increases by two to three fold as compared to younger age group with greatest prevalence is in elders over 85 years. [5][6][7] Epilepsy in elderly compared with younger adult population differs in etiology, clinical presentation and prognosis.Management of epilepsy in elderly individual can be complicated by many factors including concurrent medical illnesses, drug interactions, changes in pharmacokinetics and altered central nervous system pharmacodynamics. Adverse effects of anti-epileptic drugs and sei...

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Section: Discussionsupporting

confidence: 48%

Seizures and Epilepsy in Elderly: A Tertiary Care Centre Hospital Based Study

Sarmah¹,

Kharbanda²,

Prabhakar³

2015

jemds

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“…Transient global amnesia (TGA) can be confused with seizure activity [24] . TGA is a clinical syndrome characterized by a number of clinical features: a clear-cut anterograde amnesia with no clouding of consciousness or loss of personal identity, the absence of neurological signs or deficit, no features suggesting epilepsy or active epilepsy, no recent head injury, and resolution within 24 h [25] .…”

Section: Seizures In Elderly Patients With Dementia: Diagnosismentioning

confidence: 99%

Epilepsy and Dementia in the Elderly

Hommet

Mondon²,

Camus³

et al. 2008

Dement Geriatr Cogn Disord

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Epilepsy is a frequent condition in the elderly; however, it remains a relatively understudied condition in older adults with dementia. The diagnosis of a seizure is particularly difficult and is most often based on questions to the caregiver. Epilepsy in dementia has significant consequences on the prognosis of the underlying dementia: it can result in a worsening of cognitive performance, particularly in language, as well as a reduction in autonomy, a greater risk of injury and a higher mortality rate. In this review, management strategies are recommended for the clinician. The presence of pre-existing Alzheimer’s disease does not exempt the clinician from ruling out other symptomatic causes of seizures. Anti-epileptic drugs (AED) should be started only after the diagnosis has been clearly established, when the risk of recurrence is high, and with monotherapy whenever possible. Although few data are available, the more recent AED offer significant advantages over the older medications in this context.

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“…An increased incidence of epilepsy occurs in the elderly population, representing a second peak in incidence of epilepsy in all age groups after an initial peak in the first years of life (1)(2)(3)(4)(5). Whereas a number of studies have examined the etiology of epilepsy in the elderly, there are few data on the nature of typical nonepileptic paroxysmal events in older patients.…”

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confidence: 99%

Video‐EEG Monitoring in the Elderly: A Review of 94 Patients

2002

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Summary:Purpose: We sought to determine the utility and results of video-EEG monitoring in elderly patients. There is an increased incidence of epilepsy in the elderly population. Few studies have assessed the characteristics of epileptic and nonepileptic seizures in this age group. Diagnostic evaluation with video-EEG monitoring is a means to distinguish these different types of events.Methods: The authors reviewed all patients aged 60 years and older who were admitted to the epilepsy monitoring unit at Columbia-Presbyterian Medical Center from January 21, 1991, to April 12, 1999.Results: A total of 94 patients and 99 patient admissions were identified, accounting for 8% of all admissions. The average age was 70 years, and the mean length of stay was 3.8 days. Typical events were recorded in 75 of the 99 patient admissions. A total of 118 seizures was recorded in 46 patients, and 98 nonepileptic events were seen in 27 patients. Of the patients with nonepileptic events, 13 had psychogenic seizures. The majority of patients with nonepileptic events were taking antiepileptic medication. Whereas 76% of the patients with epileptic events had interictal epileptiform discharges, 26% of the patients with nonepileptic events had epileptiform discharges as well.Conclusions: Video-EEG monitoring in the elderly leads to a definitive diagnosis in the majority of patients in a relatively short time. Interictal recordings are inadequate in determining the nature of paroxysmal events. Nonepileptic events are common in the elderly, including psychogenic seizures, and these are often misdiagnosed and mistreated as epileptic seizures.

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Seizures and Epilepsy in the Elderly

Cited by 91 publications

References 175 publications

Seizures and Epilepsy in Elderly: A Tertiary Care Centre Hospital Based Study

Seizures and Epilepsy in Elderly: A Tertiary Care Centre Hospital Based Study

Epilepsy and Dementia in the Elderly

Video‐EEG Monitoring in the Elderly: A Review of 94 Patients

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