Abstracts

Older persons with new onset epilepsy have a relatively good chance to achieve excellent seizure control, but some become intractable. In this study we investigated clinical risk factors related to becoming intractable in this population. This is a retrospective analysis of data from VA Coop Study 428, [quot]Treatment of Seizures in the Elderly Population.[quot] We looked at patients from our Denver site who completed at least 12 weeks of the study. Intractability was defined as one or more seizures a month. Controls were from the national multicenter database, and our local nonintractable patients. 11/50 of our enrolled patients were intractable, as were 11/36(31%) of those completing 3 or more months. 10/11(90%) had complex partial seizures as compared with 38% of the 593 national controls (p[lt]0.01). No other seizure types were significant. 6/11(66%) had a history of neoplasm upon entry (not expected to be fatal in 2 years) as compared to 22% of national controls (p[lt]0.01). No other concomenent diseases were significant, including history of alcohol abuse, cerebral vascular disease, cardiac disease, hypertension, or diabetes. Clinical notes suggesting poor phamacoadherence occured in 7/11(77%). This was significantly higher (p[lt]0.01) compared to 2/25(8%) of our patients who completed at least 12 weeks, were not intractable, but were also not pharamacoadherent. Age, sex, suspected etiology,brain imaging, and EEG were not significant. Specific drug treatment was not analyzed. Risk factors for intractability when epilepsy begins in the elderly are a history of neoplasm, complex partial seizures, and poor pharmacoadherence. Clinical suspicion of poor pharmacoadherece may be indicated when intractable epilepsy begins in an older person. (Supported by VA Cooperative Study Program)