Usefulness of prolonged video-EEG monitoring in the elderly

Lancman, Marcelo E.; O’Donovan, Cormac A.; Dinner, Dudley S.; Coelho, M R; Lüders, Hans

doi:10.1016/0022-510x(96)00092-5

Cited by 35 publications

(26 citation statements)

References 25 publications

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“…This was similar to the findings from Lancman et al (6) and Drury et al (7). Partial seizures have consistently been found to be the most common seizure type in the elderly (2-5).…”

Section: Discussionsupporting

confidence: 91%

“…Two patients with psychogenic seizures were found in the series by Lancman et al (6). In the series by Drury et al (7), seven of 10 patients had nonepileptic events, which included both medical and psychiatric diagnoses.…”

Section: Discussionmentioning

confidence: 94%

“…In their series, 18 patients were admitted for differential diagnosis of current episodes. Lancman et al (6) reviewed 20 patients older than 60 years admitted to an EMU. They found a similar mean age of 67 years and mean length of stay of 4 days, but the percentage of total admissions was only 1.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies discuss video-EEG monitoring in the elderly. This may partially be because the elderly represent a small percentage of admissions to epilepsy monitoring units, 4.6% and 1.5% in two separate studies (6,7).…”

mentioning

confidence: 99%

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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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“…This was similar to the findings from Lancman et al (6) and Drury et al (7). Partial seizures have consistently been found to be the most common seizure type in the elderly (2-5).…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

2002

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“…Lancman et al (6) published the only other article reporting the results of CCTV-EEG monitoring in the elderly. Their 20 patients, representing 1.5% of all patients who underwent CCTV-EEG recording at a major referral center, were subdivided into two groups, a diagnostic group of nine patients most closely comparable to our patients and a characterization group of 13 patients in whom the diagnosis of epilepsy was reasonably certain but the precise type unclear.…”

Section: Discussionmentioning

confidence: 99%

Value of Inpatient Diagnostic CCTV‐EEG Monitoring in the Elderly

et al. 1999

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Summary: Purpose: To examine the outcome of inpatient diagnostic closed circuit TV-EEG (CCTV-EEG) monitoring in a consecutive series of elderly patients admitted to an adult epilepsy-monitoring unit (EMU) over a continuous 6-year period.Methods: Retrospective review of all admissions to a university hospital adult EMU. Those older than 60 years were identified. Patients who were monitored for status epilepticus were excluded. Data on duration of events, frequency of events, physical examination, medications, preadmission EEG, brain imaging, length of stay, and interictal and ictal EEG were obtained.Resulfs: Of the 18 patients admitted for monitoring only, mean age was 69.5 years (range, 60-90 years). Mean length of stay was 4.3 days (range, 2-9 days). Five patients had complex partial seizures recorded. Three patients, all treated with antiepileptic drugs (AEDs), had no spells recorded, and no additional diagnostic information was gained from the admission. The other 10 patients, eight of whom had been treated with AEDs, were symptomatic during their admission, leading to a variety of neurologic but not epileptic, psychiatric, or other medical disorders, and allowing tapering of AEDs.Conclusions Incidence figures suggest that there are between 45,000 and 50,000 new cases of epilepsy or first unprovoked seizures among the elderly each year in the United States (1). In a Dutch population-based study, the prevalence of epilepsy in the elderly increased with age from 0.7% for those aged 55-64 years to 1.2% for those aged 85-94 years ( 2 ) . Despite this, there is little published information about the characteristic presentation of seizures in this age group, the results of diagnostic investigations, and long-term outcome. Closed-circuit television (CCTV)-EEG recording, useful in the diagnosis and classification of epileptic syndromes, seems especially underused in this population where a wide differential diagnosis exists, the yield of interictal EEG recordings is extremely low (3), and in patients with established epilepsy, the ictal semiology may change with age (4). We report the results of inpatient diagnostic CCTV-EEG reAccepted January 6, 1999. Address correspondence and reprint requests to Dr. I. Drury at 2799 W. Grand Blvd., Detroit, MI 48202, U.S.A. cordings in patients aged 60 or older admitted over a consecutive 6-year period to a university hospital epilepsy-monitoring unit (EMU). METHODSThe EMU maintains a computerized database on all admissions. Between 1/1/92 and 12/31/97, 976 adults were admitted for monitoring. Of the 557 patients admitted for diagnostic monitoring 26 (4.6%) were older than 60 years. Eight were critically ill with known or suspected status epilepticus; in 18 patients, the monitoring study was for diagnostic purposes. Each patient had a history taken and physical examination by one of the authors before CCTV-EEG monitoring, when reports of patient behaviors during spells also were obtained from lay observers. A detailed description of the methods used in our EMU was reported previo...

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Non-epileptic seizures of the elderly

et al. 2004

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NES are a frequent problem in elderly patients referred to a comprehensive epilepsy center. In contrast to a younger control group, physiological and psychogenic NES are equally frequent in the elderly. Loss of responsiveness was seen in only 20% of patients with psychogenic NES. Although most of the patients did not have any evidence for epilepsy, more than two thirds of these patients had been placed on anticonvulsive drugs.

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Usefulness of prolonged video-EEG monitoring in the elderly

Cited by 35 publications

References 25 publications

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

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

Value of Inpatient Diagnostic CCTV‐EEG Monitoring in the Elderly

Non-epileptic seizures of the elderly

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