Abstracts

In last decades the rapid growth of the elderly population and the progressively higher incidence of epilepsy in this age group has been reported. The diagnosis of epileptic seizures at admission to hospital brings variety of specific problems. We are often faced with difficulties in obtaining the reliable reports on seizure course and the interictal discharges in EEG are found less frequently than in the younger epilepsy population. Besides, a correct recognition of nonconvulsive SE may cause a special diagnostic problem, because of non-characteristic clinical picture dominated by disturbances of consciousness. Therefore the data on occurrence of epileptic seizures in the elderly have been different in particular reports.
The aim of our prospective study was to assess the number of admissions of elderly patients to the neurological ward presenting with the first epileptic seizures and to evaluate the etiology and clinical features of the seizures.
During the period of 2000-2002, 2986 patients aged 60 or older were admitted to our Neurological Departments; among them there were 137 (4.6%) patients with the first ever epileptic seizures. There were 66 males and 71 females in this group, aged from 60 to 98 yrs. In all patients CT or MRI and repeated EEGs or Video/EEG monitoring were performed. 91 (66.4%) patients were admitted because of single seizures and in the remaining 46 (33.6%) status epilepticus (SE) was diagnosed.
In the group of 91 patients with single seizures the etiology was established in 94.5%. The dominating cause (63.7%) was vasogenic brain lesion (acute stroke: 8.8%, history of stroke: 54.9%). Generalised tonic-clonic seizures were the most often observed (74.4%), less frequent were partial seizures (20.8%) and myoclonic seizures (4.4%). In EEG localised slow waves were the most frequent finding (41%), whereas interictal epileptiform discharges were rarely observed (17.6%). CT/MRI scans revealed organic brain damage in 64 patients with predominance of multifocal lesions. In the group of 46 patients with de novo SE the symptomatic etiology was established in 42 (91.3%), in the majority of cases these were vascular lesions: acute stroke (19.6%) and poststroke changes (56.5%). CT/MRI examinations showed focal brain lesions in 76% of cases; multiple lesions were the most common findings. On the basis of EEG in 23 patients convulsive SE and in 23 nonconvulsive SE (NCSE): partial in 21, generalised in 2 subjects were identified.
Our results indicate that one-third of the newly diagnosed seizures in the elderly are manifested as SE. De novo SE occurs in half of the cases in form of nonconvulsive SE, mainly as a partial complex NCSE. The majority of newly identified seizures in the elderly were of vascular origin, with predominance of multifocal vascular brain lesions.