Objective

The incidence of epilepsy increases with age. With current demographic trends, this presents a healthcare challenge. We investigated the clinical spectrum of first seizures, evaluated neuroimaging and EEG findings, and determined clinical outcomes, including anti-seizure medication (ASM) response in older people. In addition, we sought to understand the relative effects of age and frailty on ASM response.

Methods

A retrospective single centre cohort study of 207 cases ≥60 years' old, 113 of whom were eventually diagnosed with a first seizure in a specialist epilepsy clinic.

Results

65/113 (57.5%) presented with either focal aware or focal impaired awareness seizures. Stroke was the most common aetiological association (31.9%, 36/113), and odds of seizure recurrence did not significantly differ between aetiologies. 55/86 (64.0%) who started an ASM had no seizure recurrence. 14/48 (29.2%) who underwent EEG had epileptiform abnormalities, however EEG result directly affected management in only 4/48 (8.3%). The most common MRI findings were small vessel disease (37/93, 39.8%), stroke (27/93, 29.0%) and global atrophy (14/93, 15.1%). Increasing age and frailty did not affect the odds of seizure recurrence or of experiencing ASM side effects. Severity of small vessel disease or atrophy did not affect odds of seizure recurrence.

Conclusion

Our data inform the management of first seizures in older people and provisionally support the use of ASMs in patients with increasing age and frailty, despite concerns over polypharmacy and comorbidity. Our findings should be replicated in larger cohorts.

中文翻译：

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老年人新发癫痫：临床特征、病程和结果

客观的

癫痫的发病率随着年龄的增长而增加。根据当前的人口趋势，这对医疗保健提出了挑战。我们调查了首次癫痫发作的临床谱，评估了神经影像学和脑电图结果，并确定了临床结果，包括老年人的抗癫痫药物 (ASM) 反应。此外，我们试图了解年龄和虚弱对 ASM 反应的相对影响。

方法

一项回顾性单中心队列研究，纳入 207 例≥60 岁的患者，其中 113 例最终在癫痫专科诊所被诊断出首次癫痫发作。

结果

65/113 (57.5%) 表现为局灶性意识或局灶性意识障碍癫痫发作。中风是最常见的病因关联 (31.9%, 36/113)，并且癫痫复发的几率在病因之间没有显着差异。开始 ASM 的 55/86 (64.0%) 没有癫痫复发。接受 EEG 的 14/48 (29.2%) 有癫痫样异常，但仅 4/48 (8.3%) 的 EEG 结果直接影响管理。最常见的 MRI 发现是小血管疾病 (37/93, 39.8%)、中风 (27/93, 29.0%) 和全身萎缩 (14/93, 15.1%)。年龄增加和虚弱不会影响癫痫复发或经历 ASM 副作用的几率。小血管疾病或萎缩的严重程度不影响癫痫复发的几率。

结论

我们的数据为老年人首次癫痫发作的管理提供信息，并暂时支持在年龄增加和虚弱的患者中使用 ASM，尽管存在多种药物治疗和合并症的担忧。我们的发现应该在更大的队列中复制。