Analysis Of The Clinical Characteristics And Prognosis Of Epilepsy In The Elderly In Northern China With Convulsive Seizures As The First Symptom

Objective:To study the clinical characteristics, treatmentand prognosis of epilepsy in the elderly innorthern China with convulsive seizures as the first symptom.Methods:One hundred and sixty elderly epilepsy patients with convulsive seizures as the firstsymptom admitted to Neurological department of our hospital from January2010toDecember2014were included in this study. Their clinical data and prognosis those knownby telephone or outpatient follow-up were retrospectively analyzed.Results:The160cases of epilepsy in the elderly:(1)101males and59females were included,male:female﹦1.7:1. The onset age when they had epileptic seizures ranged from60to92years old, the average was(70.11±7.56) years and50.6％of them were aged over70years.The course of epileptic seizures was0to17years, the average was(2.88±2.75) years.(2)Comorbidity:There were135patients having comorbidities, theaverage comorbidity was (2.06+1.09). The comorbidities included84（52.5%）patients withhypertension disease,56（35.0%） with heart disease,33（20.6%） with diabetes mellitus,23（14.4%） with hyperlipidemia，other common comorbidity was tumor, anemia, chronicrenal insufficiency, liver disease, etc.(3) Imaging manifestations: There were13cases ofoutpatients without imaging data, all hospitalized patients had done imagingexamination.There were92patients having cranial MRI examination and88of them wereabnormal. The abnormal appearances were those single or multiple lacunar cerebralinfarction in49cases, encephalomalacia in33cases, cerebral atrophy in38cases,intracranial focal ischemia in29cases, cerebral white matter in27cases, acute cerebralinfarction in22cases, the others were intracranial placeholder, inflammation, etc. The rest of55patients had done head CT examination, the results were all abnormal, mainly werecerebral infarction, cerebral atrophy, encephalomalacia loose, leukoaraiosis,cerebralhemorrhage,etc.(4)Ofthe119epilepsy patients who underwent electroencephalography,103showed a positive discharge which was mainly manifested as abnormal background in32（26.9%）cases,interictal detected scattered or paroxysmal Sharp wave, spike wave, sharp slow, slow spines composite wave in68(57.1%）cases, clinical/electrical seizure in23（19.3%） cases,status epilepticus in7（5.9%）cases,diffuse or limited θ/δ waves in43（36.1%）cases.(5)Blood AEDs concentration and other auxiliary examination: Of29epilepsy patients who underwent the blood concentration of single or multiple antiepilepticdrugs.22patients taken small dose and18of them reached the effective blood concentration.The other12cases taken normal dose and8of them reached the effective bloodconcentration.113hospitalized patients underwent liver and kidney function, blood routine,blood ions and ECG examination, which abnormal of liver function was in43cases, renalfunction was abnormal in15cases, blood routine was abnormal in55cases, ion wasabnormal in36cases, ECG was abnormal in35cases.(6)139cases had a clear cases,namely,77cases with cerebrovascular disease, intracranial infection in13cases, intracranialtumors in13cases,11cases with traumatic brain injury, the rest were mainly cerebralatrophy, degeneration disease, non-ketotic diabetes mellitus, anoxic encephalopathy etc.21cases were not found a clear cause, in which10cases were showed lacunar cerebralinfarction in imaging, but didn’t have the clinical manifestation.(7) The type ofepilepsy:The clinical manifestations consisted of partial seizures in95cases in which simplepartial seizures in26cases, complex partial seizures in31cases and secondary GTCS in38cases; GTCS in45cases, tatus epilepticus in20cases.(8)Treatment: there were138cases receiving antiepileptic drugs treatment, including112cases of single drug, mainlycarbamazepine, oxcarbazepine, levetiracetam, lamotrigine, valproic acid etc. thecombination of drug treatment in26cases.(9)Prognosis:138cases were followed up,2patients were misdiagnosed as epilepsy in the elderly patients through follow-up,1case washysteria,1case was cardiogenic syncope.101cases taken antiepileptic drugs regularly.77cases taken single drug, in which64cases (83.12%)taken small dose and effective controlin60cases (93.75%),13cases (16.88%) taken normal dose and effective control in10cases(76.92%).The total effective cases in single drug treatment were70(90.91%);24cases weregiven two or more than two kinds of drugsin combination therapy,18cases of effectivecontrol.Conclusion:Epilepsy in the elderly was more common in male. The majority of senile epilepticssuffer from secondary epilepsy, cerebrovascular disease is the main cause of epilepsy in theelderly; partial seizures seizure is the main form of epileptic seizure; Encephalography for elderly epilepsy patients has high positivedischarge; The small dose of single antiepilepsydrug has excellent therapeutic effects in the elderly.