Abstracts

Rationale: Epilepsy is often thought of as a disease of youth, despite its' known bimodal incidence. A quarter of all new onset seizures occur in those aged 65 and older, with this number expected to double by the year 2020. We aimed to study whether geriatric patients with new onset seizures were different than similarly aged patients with longstanding epilepsy. Methods: Following IRB approval, a retrospective review was performed identifying all patients age 65 years or older seen at our institution between January 2013 and July 2014, utilizing billing codes to identify those patients seen for seizures/epilepsy (ICD codes 345, 780). Of these patients, 100 were randomly selected and a detailed collection of clinicopharmocologic and demographic data was performed. Patients with unconfirmed diagnosis of epilepsy or psychogenic nonepileptic seizures were excluded. Age of onset of seizure disorder was identified, and patients were stratified into Geriatric Onset Epilepsy (GOE; onset 60 years or older) and non-GOE (age of onset less than 60 years). Results: A total of 89 patients were identified for analysis. No difference in gender was noted (45 women, 51%). Mean age was 73 years (range 65-92 years). A total of 49 patients (55%) were identified to have GOE. An inciting factor (e.g. CNS neoplasm/infection/trauma, stroke, ICH, history of encephalopathy or febrile seizures) was identified in significantly more of the GOE group compared to the non-GOE group (73% vs 53%, p=0.0481). Overall fair control of seizures was achieved in both groups, with seizure frequency of 1 or less per year in 68% of GOE and 66% in non-GOE groups (p=1.0, no difference). Seizure control was achieved with significantly less AED in the GOE group, with 77% controlled with monotherapy, versus 38% in the non-GOE group (p=0.0004). GOE exhibited less generalized seizure presentation compared to the non-GOE group (14 vs 23%), but this was not statistically significant. No difference was noted in secondary generalization of seizures (45% in both groups). Conclusions: Geriatric patients with new onset epilepsy have distinct etiology and clinical characteristics versus similar aged patients with long-standing epilepsy. They are noted to have reduced pharmacologic needs, which may allow for minimization of polypharmacy in this vulnerable population. Further study is warranted in this expanding and clinically important population.