Authors :
Presenting Author: Syeda Amrah Hashmi, MD – Department of Neurology, University of Virginia
Muhammad Asjad Abbas, MD – Department of Neurology, University of Virginia
Mark Quigg, MD MSc – Department of Neurology, University of Virginia
Jaideep Kapur, MD PhD – Department of Neurology, University of Virginia
Ifrah Zawar, MD MS-CR – University of Virginia Heatlh
Rationale:
Late-onset epilepsy(LOE), defined as recurrent seizures starting after the age> 65 is increasingly being recognized as an entity distinct from early-onset epilepsy(EOE). to EOE, LOE is mainly associated with acquired etiologies such as stroke and neurodegenerative disorders. It poses unique diagnostic and therapeutic challenges, including atypical seizure manifestations, higher comorbidities, and increased frailty. Despite these challenges, LOE remains understudied. Further research is required to elaborate on how EOE and LOE differ to optimize management strategies. This study aims to characterize the differences in clinical presentation, seizure characteristics and outcomes between LOE and EOE, to improve prognostication and develop targeted therapeutic interventions.Methods:
This is a retrospective, single-center study. All patients who presented to UVA between August-September 2024 with a clinical diagnosis of epilepsy, based on ICD-10 criteria, were screened. Those who met the clinical diagnosis of epilepsy based on history, EEG, neuroimaging and anti-seizure medication use were eventually included. Patients were categorized into EOE vs LOE based on an age-at-onset cutoff of 65 years. Data were collected from electronic medical records, including demographic (sex, handedness, ethnicity, marital status, race, education, occupational status, living support), comorbidity (anxiety, depression, Charlson Comorbidity Index), and seizure-related variables (age at onset, seizure type, history of status epilepticus, outcomes). EEG and MRI findings were also recorded. Data were analyzed using Pearson’s Chi-squared, Fisher's exact, or t-tests.
Results:
Of the 74 patients who met inclusion criteria, 37(50%) were classified as LOE (Table 1). The mean age at epilepsy onset was 57.7±8.2 years for EOE and 72.8±6.3 years for LOE (p< 0.001). Women were more likely to have LOE than EOE (LOE=62.2% vs EOE=37.8%, p=0.0377). LOE group was more likely to be white than non-white(89.2% vs 70.3%, p=0.0496). EOE patients were more likely to be disabled compared to LOE (16.2% vs 0%, p=0.010). The burden of comorbidity, as measured by the Charlson Comorbidity Index, was significantly greater in the LOE group (mean 5.11±2.07 vs.3.84±1.95, p=0.0082). Both groups had similar proportions of focal and generalized seizures. Drug-resistant epilepsy(DRE) was observed in 4(10.8%) EOE patients, against none in the LOE group. Routine EEG was performed in 25(67.6%) EOE and 27(73.0%) LOE patients; seizures were recorded in one patient from each group (Figure 1). Epileptiform discharges or seizures were detected in comparable proportions of EOE and LOE patients (28.0% vs 25.9%). MRI abnormalities were present in 92.5% of patients overall.
Conclusions:
LOE and EOE patients exhibit distinct clinical profiles, with LOE patients more frequently female and white, and demonstrating greater comorbidity and lower levels of disability. DRE was observed only in the EOE group. EEG findings revealed epileptiform abnormalities in >25% of the overall cohort. These differences underscore the need to investigate LOE as a distinct epilepsy type to develop individualized management strategies based on age of onset.Funding: None