EEG and semiology in the elderly: A systematic review.

Seizure

Department of Clinical Neurophysiology, Danish Epilepsy Centre*, Visbys Allé 5, 4293 Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital*, and Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark. Electronic address:

Published: September 2024

AI Article Synopsis

  • Epileptic seizures are increasingly common in the elderly but often go unreported and undiagnosed, leading to delays in treatment; this review aims to raise awareness and improve diagnosis for this population.
  • The study systematically reviews 102 original research studies focusing on EEG findings and seizure characteristics in older adults, categorizing results into four distinct groups.
  • Key findings indicate that about half of elderly individuals show EEG abnormalities, with focal onset seizures being the most prevalent, and highlight the complex relationship between epilepsy and dementia in older age.

Article Abstract

Introduction: The prevalence and incidence of epileptic seizures and epilepsy increases among the elderly. Epileptic seizures in older people remain often unreported and undiagnosed, contributing to incorrect or delayed treatment. The goal of our review paper is to increase awareness of seizures in the elderly, to improve the diagnostic process in this growing population.

Methods: We present a systematic review of the literature on EEG findings and seizure semiology among the elderly according to the PRISMA statement. One hundred and two original studies were included and findings were divided in four groups: EEG among elderly without seizures, EEG among elderly with seizures or epilepsy, semiology, and status epilepticus.

Conclusions: EEG abnormalities are found in approximately half of the geriatric population referred to routine EEG. Slowing (both focal and diffuse) is the most common finding among seniors with and without seizures. Interictal epileptiform discharges (IEDs) are likewise seen among healthy seniors, which reduces their specificity as biomarker for epilepsy. Focal onset seizures prevail among the aged. Generalized seizures are uncommon, starting usually earlier in life but exacerbating in later years. Motor phenomena are less frequently seen than among younger individuals. Seizures are mainly characterized by impairment of awareness, disturbed cognition and confusion, both ictally and postictally. Unresponsiveness may occur during non-epileptic events too, which further challenges seizure recognition. Epilepsy and dementia are bi-directionally related: dementia carries an increased risk of developing epilepsy and vice versa. Up to 45 % of the aged with new onset seizures present with status epilepticus (SE). SE among the elderly is more often focal motor; non-convulsive status epilepticus (NSCE) constitutes 10-25 %.

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Source
http://dx.doi.org/10.1016/j.seizure.2024.09.003DOI Listing

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