Details
Category: Volume 06 Issue 12 December 2018
Hits: 1425

Title: Clinical profile and outcome in elderly patients with epilepsy in a neurology tertiary care centre in eastern India

Authors: Dr Meghraj Singh Patel, Dr Ritesh Yadav

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.08

Abstract

Background: Epileptic seizures (ESs) are common neurological problem in the elderly. The underlying etiology and treatment of ESs is different in elderly due to underlying comorbidities and physiological changes with aging. Precise data on this topic are not readily available from developing countries.

Aims: To study the clinical presentation, EEG and Neuroimaging correlation and response to drug treatment in elderly with ESs.

Setting and Design: longitudinal descriptive study.

Material and Methods: The patients were selected who had ESs first time after 60 years of age, were interviewed, examined, investigated and follow up for 3 months to see the response of drug treatment. Data were recorded on pre-set proforma.

Statistical analysis: Used simple percentage and proportion to analysed the data.

Results: There were 66 patients (38 male). Mean age was 62.33 year. ESs was partial with or without secondary generalization in 62.12% of cases. Symptomatic localization related epilepsy (LRE) was most common syndrome (66.67 %). MRI suggestive of stroke as a most identifying etiology in 43.93% of patients. Ratio of patients on monotheraphy and polytheraphy was 2.3:1. At the time of last follow up percentage of patients in Engel’s score 0-4 category were increased from 4.54% to 54.54%.

Conclusion: LREs were the most common type of ESs (76%) with stroke were most common identifying lesions on MRI (43.93%). Most of the patients were on monotherapy (69.7%). Significant reduction in ESs frequency was seen at the time of last follow up.

Keywords: Elderly, Epileptic seizures, Engel’s score.

References

  1. Berg Anne T et al, Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009.2010 Apr;51(4):676-85.
  2. Nisha Jacob, Sanjeev V Thomas, PS Sarma. Anti epileptic drug usage and withdrawal in elderly persons with epilepsy. Annals of Indian academy of Neurology 2007; 10:34-38
  3. Hauser W. Seizures disorders: the changes with age. Epilepsia 1992;33(4Suppl.):S6–14.
  4. Jallon P, Goumaz M, Haenggeli C, Morabia A. Incidence of first epileptic seizures in the canton of Geneva, Switzerland. Epilepsia1997;38:547–52.
  5. Loiseau J, Loiseau P, Duche B et al.: A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol 1990;27:232–
  6. De Toledo JC. Changing presentation of seizures with aging: clinical and etiological factors. Gerontology 1999;45:329–35.
  7. Ettinger AB, Shinnar S. New-onset seizures in an elderly hospitalized population. Neurology 1993;43:489–92.
  8. Granger N, Convers P, Beauchet O et al. First seizure in subjects over 60 years: electroclinical and etiological data. Rev Neurol 2002;158:1088–95.
  9. McAreavey MJ, Ballinger BR, Fenton GW. Epileptic seizures in elderly patients with dementia. Epilepsia1992;33:657–60.
  10. Paradowski B, Zagrajek M. Epilepsy in middle-aged and elderly people: a three year observation. Epileptic Disord 2005;7:91–5.
  11. Tallis R, Boon P, Perucca E, Stephen L. Epilepsy in elderly people: management issues. Epileptic Disord 2002;4(2 Suppl.):S33–9
  12. Hiyoshi T, Yagi K. 2000. Epilepsy in the elderly. Epilepsia, 41(Suppl 9):31–5
  13. Waterhouse EJ, Delorenzo RJ, Status epilepticus in older patients: epidemiology and treatment options. Drug Aging2001;18(2):133-42.
  14. Drury I, Beydoun A. Interictal epileptiform activity in elderly patients with epilepsy. Electroencephalogr Clin Neurophysiol1998;106:369–73.
  15. Bladin C, Alexandroy A, Bellavance A, et al. seizure after stroke: a prospective multicenter study. Arc Neurol. 2000;57:1617-1622
  16. Faught E, Peter D, et al. Seizure after primary intracerbral hemorrhage. Neurology 1989;39 1089-1093
  17. Katramados AM1, Burdette D et al Periictal diffusion abnormalities of the thalamus in partial status epilepticus. Epilepsia. 2009 Feb;50(2):265-75.
  18. Biraben A, Semah F et al, PET evidence for a role of the basal ganglia in patients with ring chromosome 20 epilepsy. Neurology 2004 63:73-77.
  19. Ferrendelli JA, French J, Leppik I, et al. Use of levetiracetam in a population of patients aged 65 years and older: a subset analysis of the KEEPER trial. Epilepsy Behav. 2003;4:02–9. 
  20. Bazil CW, Rose A, Resor S, et al. Levetiracetam may be more effective for late-onset partial epilepsy. Arch Neurol. 2002;59:1905–8.
  21. Garrard J, Cloyd JC, Gross C et al. Factors associated with antiepileptic dr ug use among elderly nursing home residents. J GeriontolA Biol Sci Med Sci 2000; 55:38492.
  22. Greenblatt DJ . Reduced serum albumin concentration in the elderly: A report from the Boston Collaborative Drug Surveil-lance Program. J Am Geriatr Soc 1979;27:202.
  23. Gupta S Naheedy ME lias DR ubino F Postinfarction seizure: a clinical study. Stroke,1988;19:1477-1481.

Corresponding Author

Dr Ritesh Yadav

Senior Resident NSCB Medical College Jabalpur, MP, India