Authors :
Presenting Author: Seerat Sachdeva, MBBS – Dr. S.N Medical College, India
Vineet Punia, MD, MS – Staff Physician, Epilepsy Center, Cleveland Clinic , Ohio; Ifrah Zawar, MD – Associate Professor, Neurology, University of Virginia
Rationale:
Frailty is a common age-related condition described as a decline in functional capacity across several organ systems that increases the sensitivity of an older individual to various stressors. The degree of frailty is affected not only by physical but also psychological factors such as lower cognition, depression, and other concomitant chronic diseases. However, there is a scarcity of literature about frailty in older adults with epilepsy. In a rapidly aging world and older adults constituting the highest risk age-group to develop epilepsy, we aim to provide an in-depth review of the current understanding of frailty, particularly in people with epilepsy (PWE), and the potential implications to their outcomes.
Methods:
A literature review was conducted using Medline in March 2023, using the search strategy: ((epilep*[Title/Abstract]) OR (seizure*[Title/Abstract])) AND (frail*[Title/Abstract]) ). The references in the 54 articles identified from the above search were screened and yielded 18 additional relevant articles. A full text review of these 72 studies was performed and 57 articles are. Relevant information from the papers was extracted, interpreted, and thoroughly analyzed.
Results:
Many studies used various biological markers and scales to assess the degree of frailty. Edmonton frail scale was found the most reliable to measure frailty, seemingly as it takes into account nine varied aspects of frailty, including depression, nutrition, social isolation, etc. There exists no inter-scale agreement between the frailty scales.The odds of developing dementia are higher in people with epilepsy and epilepsy may even contribute to cognitive frailty. Similarly, patients with epilepsy on long-term anti-seizure medications have an increased risk of developing not only stroke but also falls, fractures, etc., which further leads to the progression of frailty. Older adults with increased frailty more often report anti-seizure medication adverse effects. One study found that worsening frailty was associated with an increased rate of non-home discharge and mortality after epilepsy surgery on univariable analysis. The trifecta of stroke, dementia, and epilepsy in the elderly is associated with increased frailty in older adults.
Conclusions:
There is a paucity of literature on frailty and its impact on seizure outcomes in the older adults with epilepsy. Nonetheless, the literature so far suggests that frailty measures should be incorporated into routine clinical care of older adults with epilepsy. This may have implications for quality of life in older adults with epilepsy. Further research is needed to better understand the complex inter-related pathophysiology of frailty with epilepsy co-morbidities in older adults and its implications on their management.
Funding: No funding was received in support of this abstract.