OBSERVATIONS ON THE DELAY IN DIAGNOSIS OF SEIZURES IN THE ELDERLY: UPDATE 3
Abstract number :
1.040
Submission category :
Year :
2003
Submission ID :
3963
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Mark C. Spitz, Jacquelyn L. Bainbridge, K. Vanessa Winzenburg, R. Eugene Ramsay, Flavia M. Pryor, Basim M. Uthman, Brenda Smith, Sharon Edwards, Juanita Johnson, Anita Wilson, Ashlee Stocco, DVA CSP 428 Study Group Neurology, UCHSC, Denver, CO; Neurology,
The onset of epilepsy often occurs in the elderly population. From our observations, the time to correct diagnosis is often delayed. Our interest is to investigate this phenomenon.
We reviewed the charts of 159 patients enrolled in the Veterans Administration Cooperative Study of new-onset epilepsy in the elderly. No patients were profoundly demented or had known fatal illnesses. Concomitant medical diseases were permitted.
157 men and two women aged 59-96 years (mean, 71.3) of age had a mean time to correct diagnosis of seizures of 1.7 years (median, 2.5 months). Forty-nine of these were diagnosed immediately. Fifty-eight patients had generalized tonic-clonic (GTC) seizures, and half (50%) were immediately diagnosed. Eighty-six patients had complex partial seizures (CPSs), and only 20.9% had an immediate correct diagnosis. This was dependent primarily on delays by the patient for GTCs, and on both the patient and the health care providers for CPSs. If a history of cardiovascular disease was known, the correct diagnosis was significantly delayed in patients with GTC, CPS, and SPS seizures. More severe concomitant medical disorders, such as cancer, caused greater delays in the time to diagnosis. Patients presenting with only simple partial seizures (n=29) waited a median of 2 months to seek medical attention. They were diagnosed with SPSs 1 month later (median 3 months from onset to diagnosis). Twenty-three percent of patients with SPSs were incorrectly diagnosed originally as having transient ischemic attacks (TIAs). Patients with SPSs were mostly self-referred (p[lt].01), while those with CPSs or GTCs were mostly referred by family members or health care providers. Preliminary data suggest that patients over the age of 80 are more likely to be diagnosed with GTCs, and less likely to be diagnosed with SPSs, than patients between the ages of 60 and 80.
We observed significant delays in the correct diagnosis of seizures in this population. Two reasons we believe contribute to this problem are the lack of awareness of partial seizures by the public and health care providers, and an attempt to attribute all of a patient[apos]s symptoms to a single diagnosis.