Abstract
Objective: To evaluate prospectively the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including dedicated epilepsy protocol MRI.Methods and materials: We included all consecutive patients 60 years or older who participated in a prospective study on new onset epilepsy. The work-up included the acquisition of a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We evaluated the frequency and types of epileptogenic lesions in the whole cohort and stratified those variables by age, gender, types and number of seizures at presentation. We also correlated the EEG findings with the clinical characteristics and neuroimaging results.Results: Of the 101 patients enrolled in the study and who underwent an epilepsy protocol MRI, an epileptogenic lesion was identified in 67% of cases. The most common etiologies were vascular events, followed by tumoral causes and traumatic brain injuries. Epileptogenic lesions were more likely to be identified in patients who presented with only focal aware and impaired awareness seizures. In addition, patients with tumoral epilepsy were significantly more likely to only experience those seizure types compared to patients with other pathological substrates. Interictal/ictal discharges were detected in the EEG of 21% of patients. Epileptiform discharges were significantly more frequent in patients with an epileptogenic lesion on brain MRI, especially in those with a brain tumor.Conclusions: Our results stress the importance of obtaining a dedicated epilepsy protocol MRI in elderly patients with new onset seizures. An epileptogenic lesion will be identified in approximately two thirds of patients with important implications regarding initiation of treatment. In addition, the data underscore the value of distinguishing the types of seizures experienced at presentation as this will apprise the treating physician on the likelihood of identifying an epileptogenic lesion and on the probable etiologies.
Highlights
Population based studies established that the incidence of seizures increases markedly after 60 years of age[1,2,3,4,5,6], relatively few studies focusing on epilepsy in the elderly have been conducted
The purpose of this study is to evaluate prospectively evaluate the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including a dedicated epilepsy protocol MRI and a 3 h video/EEG recording
At the time of their initial evaluation, 56 patients presented with a single seizure while 45 patients experienced more than one seizure. 48 patients experienced focal to bilateral tonic-clonic seizures (40 presented with focal to bilateral tonic-clonic seizures only and 8 experienced in addition focal aware or impaired awareness seizures), whereas 53 patients only experienced focal aware and/or impaired awareness seizures. 18 patients presented with more than one seizure within a 24 h period while 4 patients presented with status epilepticus
Summary
Population based studies established that the incidence of seizures increases markedly after 60 years of age[1,2,3,4,5,6], relatively few studies focusing on epilepsy in the elderly have been conducted. The yield of detecting underlying lesions responsible for the seizures has increased over time, especially due to the more frequent use of brain MRI, known to have a substantially higher sensitivity compared to head CT scans [10]. A number of studies have reported that 50% or more of elderly patients with new onset epilepsy have no detectable epileptogenic lesion on neuroimaging [11,12,13,14,15,16,17]. The purpose of this study is to evaluate prospectively evaluate the frequency of epileptogenic lesions in a consecutive cohort of elderly patients presenting with new onset unprovoked seizures, and who underwent a complete evaluation including a dedicated epilepsy protocol MRI and a 3 h video/EEG recording. We correlated the EEG findings with the clinical characteristics and neuroimaging results
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