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The National General Practice Study of Epilepsy reported an 80% risk
of seizure recurrence in older patients at 52 weeks(1). The risk of
recurrence was greatest in those younger than 16 years as well as those
over 60 years. Remote symptomatic seizures carried a higher risk of
recurrence (85%) at three years than acute symptomatic seizures (46%).
Other studies have not found older age to be a significant predictor of
recurrence(2,3). The presence of Todd's paresis or previous acute
symptomatic seizures relating to the original insult appears to increase
the risk of recurrence(3). A retrospective study in 1986 examined
prognosis in a large group of elderly admitted to hospital following a
seizure(4). Of patients not previously treated and observed for at least
12 months, 62% remained seizure free and 26% had less than three seizures
per year; 72% of the whole group entered remission within the first year.
Although no controlled clinical trials exist, most studies report that the
vast majority of older patients with seizures are readily controlled with
a low dose of a single antiepileptic drug (AED). A Veterans Administration
trial of AEDs in adults showed that a higher proportion of older adults
achieved control than did younger adults(5). It is important to
appreciate, however, that increased age is associated with increased, not
decreased, variance and some elderly patients may still require high doses
of AEDs.
References:
1. SANDER JW, HART YM, JOHNSON AL, SHORVON SD. National General
Practice Study of Epilepsy: newly diagnosed epileptic seizures in a
general population. Lancet 1990; 336(8726):1267-1271.
2. HOPKINS A, GARMAN A, CLARKE C. The first seizure in adult life. Value
of clinical features, electroencephalography, and computerised tomographic
scanning in prediction of seizure recurrence. LANCET 1988; 1(8588):721-
726.
3. HAUSER WA, RICH SS, ANNEGERS JF, ANDERSON VE. Seizure recurrence after
a 1st unprovoked seizure: an extended follow-up. Neurology 1990;
40(8):1163-1170
4. LUHDORF K, JENSEN LK, PLESNER AM. Epilepsy in the elderly: prognosis.
Acta Neurol Scand 1986; 74(5):409-415.
5. RAMSAY RE, RUGGLES K, SLATER JD. Effects of age on epilepsy and its
treatment. Results from the VA cooperative study. Epilepsia 1994; 35
(Suppl 8):91.
Prognosis in elderly with seizures and epilepsy
Dear Editor,
The National General Practice Study of Epilepsy reported an 80% risk
of seizure recurrence in older patients at 52 weeks(1). The risk of
recurrence was greatest in those younger than 16 years as well as those
over 60 years. Remote symptomatic seizures carried a higher risk of
recurrence (85%) at three years than acute symptomatic seizures (46%).
Other studies have not found older age to be a significant predictor of
recurrence(2,3). The presence of Todd's paresis or previous acute
symptomatic seizures relating to the original insult appears to increase
the risk of recurrence(3). A retrospective study in 1986 examined
prognosis in a large group of elderly admitted to hospital following a
seizure(4). Of patients not previously treated and observed for at least
12 months, 62% remained seizure free and 26% had less than three seizures
per year; 72% of the whole group entered remission within the first year.
Although no controlled clinical trials exist, most studies report that the
vast majority of older patients with seizures are readily controlled with
a low dose of a single antiepileptic drug (AED). A Veterans Administration
trial of AEDs in adults showed that a higher proportion of older adults
achieved control than did younger adults(5). It is important to
appreciate, however, that increased age is associated with increased, not
decreased, variance and some elderly patients may still require high doses
of AEDs.
References:
1. SANDER JW, HART YM, JOHNSON AL, SHORVON SD. National General
Practice Study of Epilepsy: newly diagnosed epileptic seizures in a
general population. Lancet 1990; 336(8726):1267-1271.
2. HOPKINS A, GARMAN A, CLARKE C. The first seizure in adult life. Value
of clinical features, electroencephalography, and computerised tomographic
scanning in prediction of seizure recurrence. LANCET 1988; 1(8588):721-
726.
3. HAUSER WA, RICH SS, ANNEGERS JF, ANDERSON VE. Seizure recurrence after
a 1st unprovoked seizure: an extended follow-up. Neurology 1990;
40(8):1163-1170
4. LUHDORF K, JENSEN LK, PLESNER AM. Epilepsy in the elderly: prognosis.
Acta Neurol Scand 1986; 74(5):409-415.
5. RAMSAY RE, RUGGLES K, SLATER JD. Effects of age on epilepsy and its
treatment. Results from the VA cooperative study. Epilepsia 1994; 35
(Suppl 8):91.
Competing interests:
None declared
Competing interests: No competing interests