Clinical and Instrumental Characterization of Patients With Late-Onset Epilepsy.

Jacopo C Difrancesco,Elena Chipi,Nicola Salvadori,Cinzia Costa,Carlo Andrea Galimberti,Michele Romoli,Carlo Ferrarese,Daniela Perani,Angelo Labate

doi:10.3389/fneur.2022.851897

Abstract

Epilepsy is classically considered a childhood disease. However, it represents the third most frequent neurological condition in the elderly, following stroke, and dementia. With the progressive aging of the general population, the number of patients with Late-Onset Epilepsy (LOE) is constantly growing, with important economic and social consequences, in particular for the more developed countries where the percentage of elderly people is higher. The most common causes of LOE are structural, mainly secondary to cerebrovascular or infectious diseases, brain tumors, trauma, and metabolic or toxic conditions. Moreover, there is a growing body of evidence linking LOE with neurodegenerative diseases, particularly Alzheimer's disease (AD). However, despite a thorough characterization, the causes of LOE remain unknown in a considerable portion of patients, thus termed as Late-Onset Epilepsy of Unknown origin (LOEU). In order to identify the possible causes of the disease, with an important impact in terms of treatment and prognosis, LOE patients should always undergo an exhaustive phenotypic characterization. In this work, we provide a detailed review of the main clinical and instrumental techniques for the adequate characterization of LOE patients in the clinical practice. This work aims to provide an easy and effective tool that supports routine activity of the clinicians facing LOE.

Highlights

Epilepsy is classically considered an infantile-pediatric disease
Further confirmation is needed in larger case series, recent scientific evidence shows that Late-Onset Epilepsy (LOE) patients with an altered Cerebrospinal Fluid (CSF) profile, in particular low CSF Aβ level, have a greater chance of evolving to dementia in the years following the onset of epilepsy [9,10,11,12,13]
Many of the innovative aspects reported in this review derive from current research, mostly based on small patient series

Summary

INTRODUCTION

Epilepsy is classically considered an infantile-pediatric disease. the onset of the disease in the adulthood, after the age of 50, is common. Patients with LOE are subjected to first-level clinical and instrumental investigations that allow the identification of the causes of the disease in the majority of cases. In the routine clinical activity, patients with LOE are subjected to several first level investigations with the aim to identify the most common causes of LOE (Table 1) In most cases, these examinations allow the correct clinical-diagnostic classification of patients. The first step for the correct characterization of the patient with LOE is the collection of information about the characteristics of the seizures, both directly from the patient and from relatives/witnesses It is important an accurate collection of the objective and subjective manifestations of the episodes, when possible, with the support of video clips of the clinical manifestations, in order to facilitate the correct interpretation of the episodes.

Objective

DISCUSSION

CONCLUSIONS