First seizure in the elderly: causes, impact and perspectives

Abstract

Background. In recent years, epilepsy in the elderly has emerged as a growing public health concern. The first epileptic seizure in an older adult often represents a critical juncture, both diagnostically and therapeutically, requiring a tailored approach distinct from that used in younger individuals. Objective(s). This study aims to investigate the etiological factors, clinical characteristics, and prognostic outcomes of primary epileptic seizures with onset in the population aged over 60. Materials and methods. This retrospective study included 46 patients who experienced primary epileptic seizures after the age of 60. All patients were evaluated and followed at the National Epileptology Center. The diagnosis was established based on clinical assessment, neuroimaging, and either standard electroencephalography or long-term monitoring. Results. The average age was 72.5 ± 9.9 years, and cerebrovascular (CVD) pathology was the leading cause of epilepsy (43.5%), followed by brain tumors (19.6%). All patients presented focal epileptic seizures, most frequently with focal motor semiology (41.3%) or focal seizures evolving into bilateral tonic-clonic seizures (30.43%). In this age group, focal seizures involving one side of the body were associated with CVD in 81.8% of cases. 1/3 had ≥ 4 cardiovascular comorbidities (82.61%). A significant percentage (13.1%) included elderly individuals without an obvious cause for the seizures, no risk factors, and tonicclonic seizures during sleep. Conclusion(s). In elderlies, an apparently isolated first seizure reflects an underlying vascular brain lesion. Early recognition and diagnosis of epileptic seizures in this population are essential, as they may reduce recurrence rates and mitigate the negative impact on quality of life.