Abstracts

Rationale: The elderly population has the highest incidence and prevalence of epilepsy. These are increasing as the population ages. Special considerations surrounding epilepsy in the elderly, including epidemiological factors, socioeconomic impact, and management, exist. While more attention is being given to these issues, it is not clear how individuals who develop epilepsy later in life (>65 years) differ from other elderly patients who developed epilepsy prior to old age.Methods: Chart reviews were performed on 49 patients with epilepsy aged 65 years and older who are followed in an epilepsy clinic. Data were collected concerning age at onset of epilepsy; seizure type; co-morbid medical, psychiatric, and neurologic diagnoses; treatment and control of epilepsy; and level of functioning in the community in terms of independence and social interaction. Data were analyzed for all the patients as a group, and then for the subgroups of individuals with onset of epilepsy at age 65 or older (late-onset epilepsy, or LOE; n=13, mean age=77.3 years) versus those with epilepsy onset prior to age 65 (early-onset epilepsy, or EOE; n=36, mean age=73.3 years).Results: LOE patients were more likely to be on only one anti-epileptic medication (61.5%), compared to 30.6% of EOE patients (p=.051) and were also more likely to be on ≤2 anti-epileptic medications (100%), compared to EOE patients (55.6%, p=.051). The LOE group was also slightly likely to have better control of their seizures: 61.5% LOE was seizure-free compared to 52.8% EOE (p=.60); 92% LOE had two or fewer seizures per year, compared to 72% EOE (p=.14); 19.4% of the EOE group had at least one seizure per month, while none of the LOE group experienced this (p=.089). In terms of co-morbid conditions, LOE was more likely to have cerebrovascular disease (53.8%), diagnosis of dementia or memory loss (38.5%), or cerebral neoplasm (15.4%) than EOE. In EOE group, prevalence of cerebrovascular disease was 13.9% (p=.003), dementia or memory loss was 5.6% (p=.003), and cerebral neoplasm was 2.3% (p=.11). Patients in the LOE group (74.4%) were more likely to be living at home as opposed to assisted living or long-term care facilities compared to patients with EOE (58.3%, p=.091), and were also more likely to be driving (53.8% versus 21.9%, p=.018. LOE patients were slightly more likely to be depressed (46.2%) than the EOE group (33.3%, p=.42). Fewer of those in the LOE group were working (7.7%) than those in the EOE group (19.4%, p=.34). Outcomes in terms of social and physical activity were very similar for the two groups.Conclusions: Patients who develop epilepsy at older ages experience better seizure control, are on significantly fewer AEDs and are more likely to be driving. Trends suggest differences between the groups in independence of living, prevalence of depression and employment. This information given to new onset patients may be helpful in planning, prognosis and therapy discussions.