Abstracts

Rationale: Incidence of epilepsy rises sharply after age 60. It has been suggested that mortality in elderly patients with epilepsy (EPWE) is 2-3 times greater than the general population. Higher prevalence of epilepsy related complications like status epilepticus, comorbidities and medication effects are speculative causes for poor outcome. To get an understanding of epilepsy care in the elderly systematic evaluations are needed. Methods: We retrospectively studied management of EPWE at Vanderbilt University Epilepsy Center and analyzed their outcome. EPWE seen in the epilepsy clinic from January 2005 to December 2011 above age 65 years were identified by their diagnostic codes for epilepsy (ICD-9 345.0-345.9) and seizures (ICD-9 780.39). We extracted demographic data and variables pertaining to management outcome. Data were then collected by careful electronic patient chart review. Statistical analysis was done using the statistical software R version 3.0.1.Results: The search yielded a total of 196 patients. Diagnosis of epilepsy was confirmed in 176 (mean age 73.2 6.1 years; 91 male and 85 female). Epilepsy classification was available for 142 patients 92% of whom had partial epilepsy. Comorbidities were common and included hypertension (65%), diabetes mellitus (24%), stroke (23%), and depression (23%). Epileptiform abnormalities were found on EEG in 41 patients while 40 patients had non-epileptiform abnormalities; 56 of the patients had normal EEG. Most of the patients (77%; n=176) were on antiepileptic drugs (AEDs) at presentation; 34% were on newer generation AEDs while 27% were on older generation AEDs, and 16% were on a combination of both. AED was changed from baseline in majority (91) of the patients while AED dose was changed in 58 patients. Mean duration of follow up was 23.75 28.78 months but about half (87) of the patients were lost to follow up and 37 of them did not come back after the first visit. Majority of the patients (79%; n=115) for whom seizure frequency at the first and last follow up visits were available reported decrease in seizure frequency. During the follow up period, status epilepticus was reported in 8 (5 male and 3 female) patients with no fatalities.Conclusions: Majority (79%) of EPWE in our epilepsy clinic reported improved seizure control; however, half were lost to follow-up and nearly 20% had a single visit. While improved seizure control in the majority is reassuring, disparity of care or indeed higher morbidity and mortality is speculated for poor follow-up and merits further evaluation.