Elderly patients with epileptic seizures: in-patient observational study of two French community hospitals

Epileptic seizures (ESs) in the elderly are recognized as frequent, and potentially difficult to diagnose. Their clinical features and relevant diagnostic problems still remain poorly investigated in hospital populations outside the setting of tertiary referral centres. In this study we attempted to improve the understanding of these aspects in community institutions. We conducted a four-year retrospective observational study of 104 consecutive elderly patients with the diagnosis of ES, in 2 French community hospitals. Most ESs were partial (n=50; 48.07%) but generalized ESs were also clinically frequent (n=41; 39.42%). Brain imaging was highly contributive for the diagnosis of partial ESs by demonstrating causative focal structural lesions. ESs were often unprovoked (n=82; 78.84%). Fifty six of these (68.29%) were symptomatic. Stroke lesions were the most identified cause (n=17; 20.73%). In 26 patients (31.70%) aetiology was unknown. Various diagnostic problems were identified. Inter-observer agreement between neurologists and non-neurologists based on clinical judgement was only "fair" (kappa coefficient: 0.28; 95% CI; p=0.002). ESs were initially misdiagnosed in 28 patients (26.92%). The misdiagnosis rate was higher among non-neurologists (n=25; 89.28%) as compared to neurologists (n=8; 28.57%) (p<0.0001). The presence of focal neurological abnormalities was an important diagnostic indicator of a positive diagnosis of ES. In conclusion, ESs in the elderly are generally partial, unprovoked and symptomatic, and caused by stroke-related lesions. Many are still overlooked, highlighting the important role of specialist input and rigorous clinical evaluation for diagnostic confirmation.