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The natural history of late-onset epilepsy secondary to vascular disease
D R Fish1, D H Miller, R C Roberts
1University Department of Clinical Neurology, National Hospital for Nervous Diseases, London, United Kingdom.
Insights
Late-onset epilepsy, often linked to stroke, shows a good prognosis. Seizure control is excellent when epilepsy begins soon after a cerebrovascular event.
Area of Science:
- Neurology
- Epileptology
- Stroke Medicine
Background:
- Late-onset epilepsy presents diagnostic and prognostic challenges.
- Cerebral infarction and stroke are potential causes of new-onset seizures in adults.
- Understanding epilepsy prognosis after stroke is crucial for patient management.
Purpose of the Study:
- To investigate the prognosis of late-onset epilepsy.
- To evaluate the relationship between cerebral infarction and epilepsy outcomes.
- To determine seizure control rates in patients with post-stroke epilepsy.
Main Methods:
- Prospective follow-up of 29 patients with late-onset epilepsy (mean 4.9 years).
- CT scans used to identify occult cerebral infarction in 14 patients.
- Separate analysis of 24 patients with epilepsy following stroke (mean follow-up 5.9 years).
Main Results:
- Similar seizure-free rates (57% vs. 53%) in patients with and without cerebral infarction.
- Excellent seizure control (100% seizure-free) for epilepsy onset within 2 weeks of stroke.
- Good seizure control (7/12) for epilepsy onset >2 weeks after stroke.
Conclusions:
- Late-onset epilepsy generally has a favorable prognosis.
- Early seizure onset post-stroke correlates with better seizure control.
- Prompt diagnosis and management of post-stroke epilepsy are recommended.
Abstract:
Twenty-nine patients with late-onset epilepsy were followed prospectively for a mean period of 4.9 years; 14 had CT evidence of occult cerebral infarction and 15 had normal scans. The prognosis was similar in the 2 groups; 57% and 53% respectively became seizure-free. One patient in each group had a myocardial infarction and one patient with occult cerebrovascular disease had a stroke. A separate study was made of the prognosis of 24 patients with epilepsy following stroke (mean follow-up 5.9 years). Twelve of 12 patients with seizure onset within 2 weeks of the stroke became seizure-free, compared with 7/12 with more delayed onset. Late-onset epilepsy has a favourable prognosis, and excellent control should be expected if seizures commence within 2 weeks of stroke.