Abstracts

Rationale: The incidence of epilepsy is high in older individuals. However, epilepsy in the elderly is underdiagnosed and undertreated due to diagnostic difficulties. Therefore, the main goal of this study was to determine whether seizure semiology differs between older and younger adults with epilepsy. Secondary goals included comparisons of risks factors for epilepsy and cardiovascular risk factors (CVRFs) between the two age groups. Methods: Fifty patients with focal epilepsy aged 55 and older and 50 patients aged between 18 and 45 years were included. Patients with cognitive impairment or those unable to report their symptoms were excluded. All patients were previously seen by the authors. Review of medical records contained detailed seizure description by the patients and/or witnesses, neurological examination, type and number of antiepileptic drugs (AEDs) and total number of medications. CVRFs included hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), dyslipidemia, obesity and smoking. Significance levels were set at 5% (α =.05) followed by a Bonferroni correction (p ≤ .0013). All analyses were conducted using SAS® v9.2. Results: Twenty-eight patients had no recollection of their seizures and 17 (17/28) of these were aged 55 or older. Subtle perceptions of transient confusion were more often seen in older patients (p=.0053) whereas secondary generalized tonic clonic seizures were more frequent in the younger group (p=.0082). No significant differences were found in other seizure types or auras between the two age groups. Monotherapy with AEDs was more often found in older patients (p=.0003). There was a positive correlation between total number of CVRFs and ageing (r =.446, p<.0001). Significant differences (p<.0001) in the incidence of HTN, CAD and dyslipidemia were found. Conclusions: Older patients tended to present more subtle symptoms of brief confusion and less secondary generalization than the younger group. Recognizing the many facets of seizure semiology in the elderly could lead to a better awareness of the possibility of epileptic seizures and therefore avoid the unwanted consequences of untreated seizures. The role of CVRFs in epilepsy remains unclear.