Abstracts

Population-based studies demonstrate an age-related increase in incidence of epilepsy after 55 years with a peak incidence at the age of 75 years and older. A detailed evaluation of seizure symptomatology in the elderly and comparison with a younger adult epilepsy group has not yet been performed. This study was performed to describe the seizure semiology in patients over the age of 60 years and to compare it with a control group of younger adults matched according to the epilepsy syndrome diagnosis.
All patients aged 60 years and older who have undergone evaluation in the epilepsy monitoring unit of The Cleveland Clinic Foundation (CCF) between January 1994 and March 2002 were included in the study. The epilepsy syndrome was determined based on all available clinical, neurophysiologic and imaging data. A control group consisting of patients aged 18-45 years was matched according to the epilepsy syndrome. Available videotapes of the seizures were reviewed by two independent observers and classified based solely on seizure semiology.
Fifty-four (3.3%) of the 1633 patients were 60 years or older at the time of admission. Six of them had no seizures during the stay. The videotapes of nine others were not available. A total of 121 seizures of 39 elderly patients (16 men, 23 women) and 137 seizures of the 39 control patients were analyzed. In both groups, there were nine patients with temporal lobe epilepsy, two patients with frontal lobe epilepsy, and two patients with parietal lobe epilepsy. Four patients had focal epilepsy lateralized to one hemisphere, another four patients had a non-localizable focal, or a generalized epilepsy. Eighteen patients had only non-epileptic seizures. In 9 elderly patients and 14 control patients, the seizures started with an aura. Eleven elderly patients and 19 control patients lost consciousness during their seizures. Ten elderly patients and 11 controls had typical automotor seizures (manual and oral automatisms). The seizure ended with generalized tonic or clonic movements in 14 elderly seizures (4 patients) and 13 seizures (9 patients) of the controls. Lateralizing signs included unilateral clonic activity, versive seizures and aphasia. They were seen in 40 seizures (14 patients) of the elderly compared to 33 seizures (15 patients) of the controls.
Only a small percentage of the patients admitted to a tertiary epilepsy referral center for long-term video-EEG monitoring is older than 60 years. Nearly half of them had non-epileptic seizures. All seizure types in the elderly were also seen in the younger control group, and vice versa. No difference in seizure semiology between elderly patients and a younger control group was found. The CCF seizure classification based solely on seizure semiology can be used successfully in elderly patients.
[Supported by: IMF University Münster Grants KE 620201 (Dr. Kellinghaus) and LO610101 (Dr. Loddenkemper)]