Clinical profile of new onset seizures in elderly population: a study at tertiary care centre in northern part of India

Purpose: Epidemiologic studies have shown that the incidence of epilepsy is the highest in the elderly population. As the elderly constitutes the most rapidly growing population in our country, epilepsy in this group has become an important health issue. To identify the characteristics of epilepsy in the elderly, etiology and effect of antiepileptic drugs on seizure control, we studied elderly population at tertiary care centre in this northern part of India for new onset of seizures. Methods: We studied all the patient with history of new onset of seizures with age above 60 years who attended neurology clininc over a period of year. All patients underwent detailed clinical history and physical examinations, various blood investigations, magnetic resonance imaging and/or computed tomography of Brain, and electroencephalogram (EEG). All patients were started on appropriate antiepileptic drugs and monitored for control of seizure and side effects of antiepileptic drugs. Results: We collected data of 118 patients who developed epilepsy after the age of 60 years. The mean age of seizure onset was 67.5 years and out of which 71% patients were males. Generalized tonic clonic seizure semiology was most frequent (n=72). Etiological diagnosis was possible in nearly 72% patients, including those with cerebrovascular disease. A clear cause of epilepsy was not found (i.e., non-lesional epilepsy) in 28% patients. Abnormal EEG was found in 46% patients. Of the 100 patients who were followed for more than 1 year, 75.5% were on antiepileptic monotherapy and 98% had been seizure-free for more than 1 year. Conclusion: In our cohort of elderly persons with new-onset epilepsy, primary generalized tonic clonic seizures was most frequent presentation. Cerebrovascular diseases formed the most frequent etiology of seizures. Epileptogenecity was relatively low in elderly patients and they responded well to antiepileptic medication.