Non-lesional late-onset epilepsy in the elderly Japanese patients: Presenting characteristics and seizure outcomes with regard to comorbid dementia

The objective of the present retrospective study was analysis of clinical, radiological, and electrophysiological characteristics of the non-lesional late-onset epilepsy (NLLOE) in the elderly Japanese patients, and comparison of the seizure outcomes in this population with regard to presence of comorbid dementia. The study cohort comprised 89 consecutive patients with NLLOE aged ≥ 65 years. In 49 cases (55%), NLLOE manifested with a single type of seizure. Focal impaired awareness seizures (FIAS) were encountered most often (in 69 patients; 78%). Ten patients (11%) had a history of the status epilepticus. Comorbid dementia was diagnosed in 31 patients (35%). Localized or diffuse white matter hyperintensity was the most common imaging finding (66 cases). Epileptiform discharges in the temporal area represented the most frequent abnormality on interictal EEG (24 cases). Seizure-free status for ≥ 12 months was attained in 46 out of 64 patients (72%), who were followed for ≥ 12 months (range, 12 - 110 months), and 42 of them received monotherapy, mainly with levetiracetam (21 patients), carbamazepine (10 patients), or lacosamide (8 patients). In comparison to their counterparts, the rate of seizure-free status for ≥ 12 months was significantly lower in patients with comorbid dementia (81% vs. 52%; P = 0.0205). In conclusion, the NLLOE among Japanese patients aged ≥ 65 years has variable presenting characteristics, and comorbid dementia is diagnosed in one-third of cases. Seizure-free status for ≥ 12 months may be attained in more than two-thirds of treated patients, but comorbid dementia is associated with significantly worse response to antiseizure therapy.

Predictors of in-hospital mortality in epilepsy and epileptic seizures in the elderly populace - A cross sectional study from rural India

AIM

This study was aimed to analyze the predictors of in-hospital mortality in epilepsy and epileptic seizures in the elderly population of the rural regions of North India.

METHODS

250 hospitalized elderly (≥60 years of age) were evaluated for predictors of in- hospital mortality who presented with epilepsy or epileptic seizures during the study period from July 2017 to September 2019.

RESULTS

The mean age of the study population was 67.2 ± 7.7 years, among them, 49.2 % (123) cases were of convulsive status epilepticus (CSE), 37.6 % (94) cases were of acute symptomatic seizures and 13.2 % (33) cases were of epilepsy. The most common etiology was a stroke in 58 % of cases. In -hospital mortality was 21.6 % and the variables significantly related with mortality on multivariate analysis were: cases with age more than 70 years (odds ratio(OR) = 2.76, 95 % confidence interval (CI) = 1.24-6.12; p = 0.013), cases with new onset CSE (NOCSE) (OR = 15.24, 95 % CI = 3.13-73.92; p = 0.001), duration of hospital stay more than ≥5 days (OR = 2.27, 95 % CI = 1.03-4.99; p = 0.042).

CONCLUSIONS

The predictors of in-hospital mortality in the elderly were related to age more than 70 years, NOCSE, longer duration of hospital stay.

Clinical and etiological profile of epilepsy in elderly: a hospital-based study from rural India

To determine the clinical profile and etiology of epilepsy in elderly patients in rural population of India which is in a phase of demographic transition with steadily growing geriatric population. A cross-sectional, prospective, hospital-based clinicoepidemiological study was performed from October 2014 to November 2015. Patients having onset of epilepsy after 60 years were incorporated in the study. We excluded the acute symptomatic seizures. One hundred and ten patients were enrolled and were divided into three standard subgroups: subgroup A (aged 60-70), subgroup B (aged 71-80), and subgroup C (aged 81-90). Out of 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. The most common etiology was cerebrovascular disease (46.36%), followed by focal cerebral calcifications single or multiple (11.81%), tumors (9.09%), trauma (6.36%) dementias (6.36%) and unknown (16.63%). In our study, the frequency of epilepsy decreases with advancing age which was 77.27% in group A (less than 70 years), 16.36% in group B and 6.36% in group C (70-90 years).The most common type of seizure in the group studied was focal 59.09% followed by generalized seizures 37.27%. Hypertension was the most common co-morbidity found in 40 (36.36%) patients. The present study proposes that epilepsy in the elderly patients have etiological relationship with stroke, focal cerebral calcifications, tumors and dementias. CNS infections account for a significant number of cases of remote symptomatic epilepsy in elderly in our region where neurocysticercosis is endemic.