Outcome of Newly Diagnosed Epilepsy in Older Patients

In the April 2013 issue of the journal Epilepsy and Behavior, Doctors Besocke and colleagues from the Department of Neurology in the Hospital Italiano de Buenos Aires, Argentina and the Hospital Privada Comunidad en Mar del Plata, Argentina, present an interesting analysis of a cohort of patients with newly diagnosed epilepsy over the age of 65 to assess how well these individuals do over time with regards to response to treatment and ultimate outcome with regards to their epilepsy. Of 122 patients that were followed over 15 months with the median age of 78 years, 55% of these had epilepsy of unknown cause and the remainder had a clearly demarcated rationale for their epilepsy. The proportions of seizure-free patients followed over time at 6, 12, 18, and 24 months were 90%, 77%, 74%, and 67%, respectively. Thirty percent of these patients experienced adverse effects and there was a higher frequency adverse effects as a number of other medications increased. 12.3% of the patients ultimately developed drug resistant epilepsy and 32% had an uncertain outcome with seizures.

Bottom Line

Patients with newly diagnosed epilepsy after the age of 65 have an excellent chance of achieving seizure control with antiseizure medications. The number of patients who end up being drug resistant in older adults is actually smaller than other age groups. However, older patients are much more likely to have side effects from drugs.

This study is important as it confirms the finding that older adults tend to fare better with regards to their seizure outcomes and response to treatment. The larger issue to contend with in this group of individuals is concern for side effects. Remember the adage that go slow and low with regards to dosage and titration schedule in order to assure success with treatment of epilepsy in an older adult.