EPILEPSY OF AGING: AN INCREASING CHALLENGE OF THE 21ST CENTURY
Keywords:
65 years, seizures, epidemiology, diagnosis, treatment
Abstract
Epilepsy in the elderly stands as the third most prevalent serious neurological condition among the older population, trailing only stroke and dementia. Approximately 15,000 individuals live with this condition in the Republic of Serbia. Despite its significance, accurate diagnosis is often hindered by various factors, leading to a perplexing scenario where it is both underrecognized and overdiagnosed. Atypical presentations of epilepsy in the elderly are frequent while the contribution of EEG diagnostics is limited by its modest sensitivity and specificity. Effective management entails prompt evaluation, precise diagnosis, initiation of suitable therapy, patient education, and comprehensive support. The ultimate aim of antiepileptic treatment is to enable patients to resume a normal lifestyle by suppressing seizures without adverse effects. Remarkably, around 80% of patients achieve steady remission with low to moderate doses of antiepileptic drugs in monotherapy. Notably, epilepsy in the elderly significantly elevates mortality, tripling the mortality rate compared to peers without epilepsy.
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10. Kotloski RJ, Dowding J, Hermann BP, Sutula TP. Epilepsy and aging. Handb Clin Neurol. 2019;167:455–75.
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12. de Toledo-Morrell L, Morrell F, Fleming S. Age-dependent deficits in spatial memory are related to impaired hippocampal kindling. Behav Neurosci. 1984 Oct;98(5):902–7.
13. Wu YW, Shek DW, Garcia PA, Zhao S, Johnston SC. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology. 2002 Apr;58(7):1070–6.
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16. Franson KL, Hay DP, Neppe V, Dahdal WY, Mirza WU, Grossberg GT, et al. Drug-induced seizures in the elderly. Causative agents and optimal management. Drugs Aging. 1995 Jul;7(1):38–48.
17. Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ. 2005 Dec;331(7528):1317–22.
18. Sirven JI. Acute and chronic seizures in patients older than 60 years. Mayo Clin Proc. 2001 Feb;76(2):175–83.
19. Forsgren L, Beghi E, Oun A, Sillanpää M. The epidemiology of epilepsy in Europe - a systematic review. Eur J Neurol. 2005 Apr;12(4):245–53.
20. Galovic M, Ferreira-Atuesta C, Abraira L, Döhler N, Sinka L, Brigo F, et al. Seizures and Epilepsy After Stroke: Epidemiology, Biomarkers and Management. Drugs Aging. 2021 Apr;38(4):285–99.
21. Bentes C, Rodrigues FB, Sousa D, Duarte GS, Franco AC, Marques R, et al. Frequency of post-stroke electroencephalographic epileptiform activity - a systematic review and meta-analysis of observational studies. Eur stroke J. 2017 Dec;2(4):361–8.
22. Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW, et al. Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010 Apr;51(4):671–5.
23. Cleary P, Shorvon S, Tallis R. Late-onset seizures as a predictor of subsequent stroke. Lancet (London, England). 2004 Apr;363(9416):1184–6.
24. Kwan J, Wood E. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane database Syst Rev. 2010 Jan;(1):CD005398.
25. Guo J, Guo J, Li J, Zhou M, Qin F, Zhang S, et al. Statin treatment reduces the risk of poststroke seizures. Neurology. 2015 Aug;85(8):701–7.
26. De Reuck J, Goethals M, Claeys I, Van Maele G, De Clerck M. EEG findings after a cerebral territorial infarct in patients who develop early- and late-onset seizures. Eur Neurol. 2006;55(4):209–13.
27. Graham NSN, Crichton S, Koutroumanidis M, Wolfe CDA, Rudd AG. Incidence and associations of poststroke epilepsy: the prospective South London Stroke Register. Stroke. 2013 Mar;44(3):605–11.
28. Zelano J, Redfors P, Åsberg S, Kumlien E. Association between poststroke epilepsy and death: A nationwide cohort study. Eur stroke J. 2016 Dec;1(4):272–8.
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