[Is it possible to diagnose all adult-onset seizures and epilepsies?]

Our capacity to recognize clinical situations--such as epileptic crises--depends on observation, clinical analysis, evolution, response to drugs and the establishment of a rational differential diagnosis of crises. Sometimes, with all these clinical factors and complementary tests, epileptic crises may be recognized and diagnosed. Thanks to current advances in neuroimaging and other complementary tests, we can recognize all the various ways in which cerebrovascular disease becomes manifest in relation to crises and epilepsies together with normal aging and dementias, and genetic factors which affect the occurrence of crises in senile patients and modulate aging of the brain. Considering the above data, it is possible to diagnose as symptomatic 80-90% of cases of epilepsy occurring in senile patients. There will be fewer cryptogenic and idiopathic cases of epilepsy in adults. The most outstanding epidemiological studies give high percentages of idiopathic cases in adults and the elderly. On critical analysis, no detailed examination is described for each patient to determine the aetiology, before labelling the case as idiopathic. In young adults, many so-called idiopathic cases of genetic origin, and occur during adolescence. These same types of epilepsy may been seen in young adults and in adolescents. Other genetic syndromes include familial temporal epilepsy, nocturnal familial frontal epilepsy, etc.