Abstracts

Patients over the age of 50 represent the fastest growing segment of the population with new onset epilepsy. Co-morbid illnesses and variability of seizure semiology often lead to initial diagnostic uncertainty in older patients with spells or epilepsy, making video/EEG (VEEG) monitoring a useful diagnostic procedure. However, the yield of VEEG monitoring in patients over the age of 50 is not well characterized. Following approval from our Institutional Review Board, all patients over the age of 50 admitted to the Iowa Comprehensive Epilepsy Program Epilepsy Monitoring Unit (EMU) were retrospectively identified. Patients were monitored in an inpatient setting with simultaneous VEEG recording. Events were identified with patient/observer event marking, computerized seizure and spike detection and review by a board certified clinical neurophysiologist. Data collected included age, sex, seizure types, interictal epileptiform discharges, ictal EEG patterns, and discharge diagnosis. Of 2,054 admissions to the EMU between January 1, 1995 and March 30, 2004, 326 (15.9%) admissions for patients over the age of 50 were identified. Patients were monitored for an average of 4.4 days (range: 1-19 days). 5 (1.5%) were diagnosed with primary generalized epilepsy and 90 (27.6%) with partial epilepsy. 77 (23.6%) patients had no spells recorded during their monitoring session, while 17 (5.2%) other patients had a non-diagnostic video/EEG. 129 (39.6%) patients were diagnosed with non-epileptic spells. 8 (2.5%) patients had multiple diagnoses following VEEG. Patients over 50 years of age constituted a minority of patients monitored in our EMU. Our retrospective analysis demonstrates that 71.2% of monitored patients over age 50 had clinical spells recorded. Of these, 31.6% were diagnosed with epilepsy, while 39.6% had non-epileptic spells. VEEG is helpful in diagnosing epilepsy or establishing an alternative spell diagnosis in a majority of patients over age 50.