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Seizures in the Elderly: Etiology and Prognosis

Published online by Cambridge University Press:  05 August 2019

Alana Holt-Seitz ,
Elaine C. Wirrell  and
Mecheri B. Sundaram
Alana Holt-Seitz
Affiliation:
University of Saskatchewan
Elaine C. Wirrell*
Affiliation:
Division of Neurology, Department of Pediatrics, University of Saskatchewan
Mecheri B. Sundaram
Affiliation:
Department of Neurology, University of Mississippi Medical Center
*
Reprint requests to: Dr. Elaine Wirrell, Department of Pediatrics, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
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Abstract:

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Purpose:

To determine the etiology, early mortality, predictors of prognosis and diagnostic yields of EEG and CT scans of the head in new-onset seizures in elderly patients.

Methods:

EEG records for the north-central region of Saskatchewan, between 01/94 and 12/95 were reviewed to identify all adults aged 60 years or older with new-onset seizures. Information on demographics, seizure type, etiology, EEG and neuroimaging studies, anti-epileptic treatment and course of epilepsy was obtained by review of medical records and interview with the patient and/or family member.

Results:

Of 88 eligible subjects, 61 (69%) were contacted for follow-up, 19 (22%) were deceased (12 of whom who had a serious underlying etiology to their seizures, which was obvious at the time of initial presentation and led shortly to their demise), 4 (5%) were lost to follow-up and 4 (5%) refused participation. Excluding those refusing participation, 74/84 (88%) patients presented with partial or secondarily generalized seizures. Seizures were cryptogenic in 38/84 (45%), and due to stroke in 19/84 (23%). EEGs were abnormal in 61/84 (73%) cases, with epileptiform discharge in 33/84 (39%). CT scans were abnormal in 57/84 (68%) cases with acute pathology in 29/84 (35%). Of the 61 patients participating in the follow-up interview, 54 (89%) were treated with anti-epileptic medication and seizure control was usually successful. Predictors for ongoing seizures were more than 3 seizures at presentation, epileptiform activity on initial EEG and discontinuation of anti-epileptic medication for lack of efficacy.

Conclusion:

Prognosis of new-onset seizures in elderly patients is favorable if seizures are not symptomatic of a life-threatening disorder.

Résumé:

Résumé:But:

L'objectif de cette étude était de déterminer l'étiologie, la mortalité précoce, les prédicteurs du pronostic et la valeur diagnostique de l'ÉEG et du CT scan cérébral chez les patients présentant des crises convulsives d'apparition récente.

Methodes:

: Les enregistrements ÉEG provenant de la région du centre nord de la Saskatchewan entre 01/94 et 12/95 ont été révisés pour identifier tous les adultes âgée de 60 ans et plus qui présentaient des crises convulsives d'apparition récente. Nous avons révisé les dossiers médicaux et procédé à des entrevues des patients et/ou des membres des familles pour obtenir de l'information sur la démographie, le type de crises, l'étiologie, l'ÉEG et les études de neuroimagerie, le traitement anti-épileptique et l'évolution de l'épilepsie.

Resultats:

Des 88 patients éligibles, 61 (69%) ont été contactés pour un suivi, 19 (22%) sont décédés (dont 12 présentaient une pathologie sous-jacente sérieuse qui était évidente à la consultation initiale et a précipité leur décès), 4 (5%) n'ont pas pu être retracés pour le suivi et 4 (5%) ont refusé de participer. En excluant ceux qui ont refusé de participer, 74/84 patients (88%) ont consulté initialement pour des crises partielles ou secondairement généralisées. Les crises étaient cryptogéniques chez 38/84 patients (45%) et dues à un accident vasculaire cérébral chez 19/84 (23%). Les ÉEGs étaient anormaux chez 61/84 (73%) avec des décharges épileptiformes chez 33/84 (39%). Les CT scans étaient anormaux chez 57/84 des patients (68%) dont 29/84 (35%) présentaient une pathologie aiguë. Parmi les 61 patients qui ont participé à l'entrevue de suivi, 54 (89%) étaient traités avec succès par une médication anti-épileptique. Les prédicteurs du non-contrôle des crises étaient plus de 3 crises au moment de la consultation initiale, une activité épileptiforme à l'ÉEG initial et un arrêt de la médication anti-épileptique par manque d'efficacité.

Conclusions:

Le pronostic des crises convulsives d'apparition récente chez les patients âgés est favorable en autant que les crises ne sont pas un symptôme d'une pathologie mortelle.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue 2 , May 1999 , pp. 110 - 114
Copyright
Copyright © The Canadian Journal of Neurological 1999

References

1. Camfield, C, Camfield, P, Gordon, K, Smith, B, Dooley, J. Outcome of childhood epilepsy: a population-based study with a simple predictive scoring system for those treated with medication. J Pediatr 1993; 122: 861–868.Google Scholar
2. Hauser, WA. Seizure disorders: the changes with age. Epilepsia 1992; 33 (Suppl. 4): S6–S14.Google Scholar
3. Hauser, WA, Annegers, JF, Kurland, LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota, 1935–1984. Epilepsia 1993; 34: 453–468.Google Scholar
4. Tallis, R, Hall, G, Craig, I, Dean, A. How common are epileptic seizures in old age? Age Aging 1991; 20: 442–448.Google Scholar
5. Luhdorf, K, Jensen, LK, Plesner, AM. Epilepsy in the elderly: inci- dence, social function, and disability. Epilepsia 1986; 27: 135–141.Google Scholar
6. Luhdorf, K, Jensen, LK, Plesner, AM. Etiology of seizures in the elderly. Epilepsia 1986; 27: 458–463.Google Scholar
7. Sung, CY, Chu, NS. Epileptic seizures in elderly people: aetiology and seizure type. Age Aging 1990; 19: 25–30.Google Scholar
8. Sundaram, MB. Etiology and patterns of seizures in the elderly. Neuroepidemiology 1989; 8: 234–238.Google Scholar
9. Schold, C, Yarnell, PR, Earnest, MP. Origin of seizures in elderly patients. JAMA 1977; 238: 1177–1178.Google Scholar
10. Hildick-Smith, M. Epilepsy in the elderly. Age Aging 1974; 3: 203–208.Google Scholar
11. Personal communication, Acute and Emergency Services Branch, Saskatchewan Health.Google Scholar
12. Dean, AG, Dean, JA, Coulombier, D, et al. Epi Info, Version 6: a word processing, database, and statistics program for public health on IBM-compatible microcomputers. Centers for Disease Control and Prevention, Atlanta, Georgia, USA, 1995.Google Scholar
13. Byrne, TN. Imaging of gliomas. Semin Oncol 1994; 21: 162–171.Google Scholar
14. Yue, NC. Advances in brain tumor imaging. Curr Opin Neurol 1993; 6: 831–840.Google Scholar
15. Baron, JC. Neuroimaging procedures in acute ischemic stroke. Curr Opin Neurol 1993; 6: 900–904.Google Scholar
16. Kuhl, V, Kiorboe, E, Lund, M. The prognosis of epilepsy with special reference to traffic security. Epilepsia 1967; 8: 195–209.Google Scholar
17. Camfield, PR, Camfield, CS, Gordon, K, Dooley, JM. If a first antiepileptic drug fails to control a child’s epilepsy, what are the chances of success with the next drug? J Pediatr 1997; 131: 821–824.Google Scholar
18. Hauser, WA. Should people be treated after a first seizure? Arch Neurol 1986; 43: 1287–1288.Google Scholar
19. Kilpatrick, CJ, Davis, SM, Tress, BM, et al. Epileptic seizures in acute stroke. Arch Neurol 1990; 47: 157–160.Google Scholar
20. Kilpatrick, CJ, Davis, SM, Hopper, JL, Rossiter, SC. Early seizures after acute stroke: risk of late seizures. Arch Neurol 1992; 49: 509–511.Google Scholar