Late-onset unexplained epilepsy: What are we missing?

Area of Science:

• Neurology
• Geriatrics
• Epileptology

Background:

• The US population is aging, leading to an increased incidence of epilepsy.
• 25-50% of new epilepsy cases in older adults have no clear cause, termed late-onset unexplained epilepsy (LOUE).

Purpose of the Study:

• To review potential pathophysiologic mechanisms underlying LOUE.
• To discuss the impact of these mechanisms on cognition.
• To explore diagnostic and treatment avenues for LOUE.

Main Methods:

• Targeted literature review.
• Analysis of potential pathophysiologic mechanisms including cerebral small vessel ischemic disease, amyloid-beta and hyperphosphorylated tau accumulation, and sleep apnea.

Main Results:

• Cerebral small vessel ischemic disease may contribute to LOUE.
• Accumulation of amyloid-beta and hyperphosphorylated tau are investigated as potential drivers of LOUE.
• Sleep apnea is considered a possible pathophysiologic factor in LOUE.

Conclusions:

• Identifying underlying mechanisms of LOUE is crucial for effective diagnosis and treatment.
• Further research into cerebral small vessel disease, proteinopathies, and sleep apnea is warranted for LOUE.
• Understanding these pathways can improve cognitive outcomes and management strategies for older adults with epilepsy.