Abstracts

Rationale: New onset seizures in the elderly is well described. However, many patients with epilepsy grow old; the aim of this cross-sectional study is to more clearly define the impact on health and psychosocial functioning of a lifetime with epilepsy. Methods: Thirty-nine patients were selected from a single community epilepsy practice. Inclusion criteria was age of >65 years, and at least a 30 year duration of epilepsy. Results: The median age was 71 years (range 65 to 92). The median duration of the epilepsy was 51 years (range 27 to 84 years). Seventy-three percent of patients had partial epilepsy, 24% generalized epilepsy and 3% mixed generalized and partial epilepsy. Of the 24 patients with partial epilepsy, 10 had known causes including head truama (1), mesial temporal sclerosis (3), vascular malformation (3), encephalitis (1), meningioma (1) and birth hypoxic injury (1). Three patients had a history of status epilepticus. Five patients had falls with injuries including fractures, concussions, or back injury. The median longest seizure free period was 8 years (range 2 days to 40 years). Fifteen patients had periods of seizure freedom longer than 5 years. Assessing seizure control over time, 33% of patients were improved, 30% were unchanged, and 36% were worse. Eighty-three percent of patients had been employed, with professions ranging from executive vice-presidents to nurses, teachers, and housewives. Two patients lost their profession due to seizures. Eighty percent were married, 10% unmarried, and 10% divorced. Thirty-two patients had children. The mean number of years of education was 13 years ( /- 4). Forty-two of patients were on one antiepileptic drug (AED), 37% on 2 AEDs, 13%on 3 AEDs, and 7% on 4 AEDs. One patient had a vagus nerve stimulator. The median number of lifetime AEDs was 4 (range 1 to 10) 35% of patients were still driving. 18% of patients had osteoporosis, and 18% had osteopenia. The incidence of major drug side effects was rare: one patient developed B cell lymphoma from carbamazepine and several patients had phenytoin associated rashes or gingival hypertrophy. No major side effects were seen with the newer AEDs. Six patients had a major depressive or anxiety disorder, and five patients were psychiatric medications. There was no history of suicide attempts. Conclusions: Elderly patients with long-standing epilepsy were more likely to have relatively well controlled partial epilepsy. Many patients had long periods of seizure freedom during their lifetime. The incidence of major drug side-effects or co-morbidities was low, most commonly low bone density and depression. Most patients had professions and families despite their epilepsy. This study demonstrates that despite a long history of epilepsy, patients may reach old age without high risk of physical or psychosocial disability.