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EEG and semiology in the elderly: A systematic review
Meritam Larsen Pirgit1, Sándor Beniczky2
1Department of Clinical Neurophysiology, Danish Epilepsy Centre*, Visbys Allé 5, 4293 Dianalund, Denmark.
Seizure
|September 18, 2024
Summary
Epileptic seizures are increasing in the elderly, often going undiagnosed. This review highlights EEG findings and seizure characteristics in seniors to improve diagnosis and awareness of epilepsy in this population.
Area of Science:
- Neurology
- Geriatric Medicine
- Epileptology
Background:
- Epileptic seizures and epilepsy prevalence rise in the elderly population.
- Seizures in older adults are frequently underreported and misdiagnosed, leading to delayed or incorrect treatment.
- There is a growing need to improve the diagnostic process for seizures in this demographic.
Purpose of the Study:
- To enhance awareness of seizures in the elderly.
- To improve the diagnostic process for epilepsy in geriatric patients.
- To review EEG findings and seizure semiology in older adults.
Main Methods:
- A systematic literature review following the PRISMA statement.
- Inclusion of 102 original studies.
- Categorization of findings into EEG in non-seizure elderly, EEG in elderly with seizures, semiology, and status epilepticus.
Main Results:
- Approximately 50% of geriatric patients undergoing routine EEG show abnormalities, with slowing being the most common finding.
- Interictal epileptiform discharges (IEDs) are present in healthy seniors, diminishing their specificity for epilepsy diagnosis.
- Focal onset seizures are more prevalent in the aged, often presenting with impaired awareness, cognitive issues, and confusion; motor phenomena are less common.
Conclusions:
- Epilepsy and dementia share a bidirectional relationship, with each condition increasing the risk of the other.
- Status epilepticus (SE) affects up to 45% of older adults with new-onset seizures, often being focal motor; non-convulsive status epilepticus (NSCE) accounts for 10-25%.
- Recognizing seizures in the elderly is challenging due to overlapping symptoms with other conditions and the occurrence of unresponsiveness in non-epileptic events.
