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Aging is a complex biological phenomenon influenced by various processes that affect cellular and systemic functions. Several prominent theories attempt to explain its mechanisms, highlighting cellular limitations, oxidative damage, and hormonal changes as central factors in aging.
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Epilepsy in the Aging Brain: Time to Rethink the Narrative.

Ifrah Zawar1, Christos Panagiotis Lisgaras2,3, Arjune Sen4,5

  • 1Epilepsy Division, Department of Neurology, School of Medicine, University of Virginia, Charlottesville, VA, USA.

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|January 30, 2026
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Summary
This summary is machine-generated.

Late-onset epilepsy (LOE) in older adults requires a shift from seizure-focused care to a brain-health model. Integrating multimodal biomarkers and multidisciplinary approaches is crucial for managing this growing population.

Keywords:
agingcognitionepilepsylate-onset epilepsymultimodal

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Area of Science:

  • Neurology
  • Geriatrics
  • Biomarker Research

Background:

  • Epilepsy in older adults is the fastest-growing global population segment.
  • Late-onset epilepsy (LOE) care is often seizure-centric, neglecting broader consequences like dementia, mortality, and stroke.
  • Older adults with LOE are underrepresented in clinical trials for both epilepsy and Alzheimer's disease (AD).

Purpose of the Study:

  • To advocate for multimodal biomarkers and multidisciplinary care for LOE.
  • To reframe LOE as a warning signal of brain vulnerability and pathology, not just a complication.
  • To propose a comprehensive brain-health framework for managing epilepsy in aging populations.

Main Methods:

  • Review of key themes and discussions from the American Epilepsy Society Annual Meeting 2025, Epilepsy and Aging Special Interest Group (SIG) session.
  • Analysis of the intersection of LOE with cognitive dysfunction, neuroimaging, electrophysiology, cardiovascular risk, sleep disruption, and AD biology.
  • Proposal of a brain-health-centered framework integrating EEG, cognitive screening, neuroimaging, and biomarker evaluation.

Main Results:

  • Cognitive dysfunction is a common, early clinical signal in LOE, often preceding neurodegenerative diagnoses.
  • LOE exists on a continuum with cardiovascular factors, sleep issues, and AD pathology, challenging traditional care silos.
  • Current care models inadequately address patient-centered outcomes like cognition, sleep, function, and quality of life.

Conclusions:

  • LOE necessitates a paradigm shift towards a brain-health-centered model.
  • Multimodal biomarkers, including longitudinal EEG and cognitive screening, are essential for effective LOE management.
  • Increased inclusion of older adults in epilepsy and AD clinical trials is critical for advancing research and care.