Clinical Features and Prognosis of First-ever Seizure in Older Adults
Background: Despite a high incidence of seizures in the older population there is limited data on the prognosis following first-ever seizure in the elderly. The perception that recurrence following first seizure is inevitable and associated with significant morbidity has led to the widespread initiation of anti-epileptic drug treatment following first seizure in this patient group.
Methods: Prospective analysis of adults seen at First Seizure Clinics of three Western Australian teaching hospitals between 2000 and 2007. The clinical features and prognosis were compared between older (aged ≥65 years) and other patients.
Results: Of 1028 patients with first-ever seizure, 124 older patients were identified (median age 74 years, 59% male). The majority of older patients were healthy (93% ambulant, 78% Rankin score ≤2, median number of medications, 3). Although variables associated with a higher risk of seizure recurrence were more commonly identified in older patients the occurrence of a second seizure was only marginally more frequent (57% vs. 49% in younger patients, p = 0.08). However within the older patient group on multivariate analysis the presence of epilepsy risk factors significantly increased the risk of recurrence (72% vs. 45% without epilepsy risk factors, p=0.005, 95% odds ratio 1.3-2.2). Elderly patients were less likely to suffer a seizure-related injury with either their first or second event.
Conclusion: Seizure recurrence following first-ever seizure is neither inevitable in the elderly nor associated with greater risk of seizure-related injury. Treatment decisions can be based on stratification of risk of seizure recurrence as in younger patients.