First seizure in elderly patients: Need to treat? Evidence from a retrospective study
Background The risk of seizure recurrence after a first unprovoked epileptic seizure is reported to be approximately 40%. Little is known about the recurrence risk after a first seizure in elderly patients, who may be at higher risk due to an increased rate of structural lesions, encephalopathy, s...
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Main Authors: | , , , , , , , , , |
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Format: | Article |
Language: | English |
Published: |
Philipps-Universität Marburg
2024
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Online Access: | PDF Full Text |
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Summary: | Background The risk of seizure recurrence after a first unprovoked epileptic seizure is reported to be approximately
40%. Little is known about the recurrence risk after a first seizure in elderly patients, who may be at higher risk due
to an increased rate of structural lesions, encephalopathy, subcortical arteriosclerotic encephalopathy or brain
atrophy.
Methods In a retrospective approach, the recurrence rate in 304 patients aged 60 years and above who presented
with a first seizure between 2004 and 2017 was analyzed. Hierarchical Cox regression was used to investigate
the impact of EEG and neuroimaging results, age or the prescription of anti-seizure medication (ASM) on seizure
recurrence.
Results Seizure recurrence rates were 24.5% and 34.4% after one and two years, respectively. Anti-seizure medication
was started in 87.8% of patients, in 28.8% despite the absence of clear epileptogenic lesions on neuroimaging or epileptiform
potentials in the EEG. Medical treatment significantly reduced the risk of recurrence (hazard ratio = 0.47).
Epileptiform potentials in the EEG, epileptogenic lesions in neuroimaging and age had no significant effect on seizure
recurrence. Age and the presence of neurodegenerative and psychiatric comorbidities showed a significant association
with ASM prescription.
Conclusions The present data show a strong protective effect of ASM on seizure recurrence in patients
above the age of 60, even in the absence of pathologic neuroimaging or EEG results needed for the diagnosis of epilepsy.
Treatment with ASM therefore seems beneficial for reducing the recurrence risk in elderly patients. The lack
of a significant association between seizure recurrence and epileptogenic lesions might be related to other confounding
factors like encephalopathy, subcortical arteriosclerotic encephalopathy, neurodegenerative diseases or brain
atrophy. |
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Item Description: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
Physical Description: | 8 Pages |
DOI: | 10.1186/s42466-024-00313-8 |