Abstracts

Epilepsy currently affects 1-1.5% of elderly being the third most frequently encountered neurologic problem in this population. Additionally, the incidence of new onset epilepsy is higher among the elderly than in any other age group. As in the general population, EEG and MRI are the cornerstones of diagnostic assessment; however, the finding of nonspecific changes associated with aging that do not necessarily indicate an underlying predisposition for epilepsy makes results difficult to interpret. The purpose of the current study is to give an overview of epidemiologic data in the elderly, focusing on etiology and seizure semiology. Retrospective database and medical records analysis of adult patients with epilepsy admitted to our Epilepsy Program from January 2004 to May 2005. 19 out of 292 (6.5%) patients, 11 women and 8 men, admitted to our program were older than 65 with a diagnosis of new-onset epilepsy. The mean age of seizure onset was 73 years old (range: 65-86). The seizure semiology included: generalized tonic-clonic seizures (GTCS) in 7 (37%), with a 57% occurring only over sleep; complex partial seizures (CPS) in 3; simple partial seizures (SPS) in 2; SPS evolving to CPS in 2 and complex partial seizures with secondary generalization (CPS-GTC) in 4. Four patients with CPS were not corretly diagnosed until they had the first GTCS.
EEG were performed in 16 of 19, only 5 (31%) showed epileptiform abnormalities consistent with the diagnosis. MRIs were obtained in 18 out of 19, five of them were diagnostic. The etiology of the epilepsy included: ischemic stroke in 2; lobar hemorrhage in 1; primary brain tumors in 2.; Alzheimer disease in 1; remaining unknown in 12 (63%). The most common seizure type seen in our series was GTCS without a clear-cut partial onset. Epilepsy was mainly cryptogenic followed by vascular or neoplastic etiology. Distinguishing epilepsy from paroxysmal nonepileptic events can be difficult as the ictal semiology may be misinterpreted as symptoms of other typical diseases in old people (syncope, transient global amnesia).Further studies in this area are still needed to establish optimal diagnostic strategies.