Clinical and Etiological Study of New-Onset Seizure in Elderly People
Authors: Kar Ayaskanta , DP Hoysalakumar , Rathor Prasanna 
Published: November 2022

Background: Elderly persons are a fast growing sector of the population that includes a substantial number of patients with seizure disorders. Because of atypical presentation, concomitant co-morbid disorders, reduced cognitive function, and parallels with prevalent diseases, new-onset seizures in the elderly are frequently difficult to identify. The current study aimed to examine the clinical and etiological features of new-onset seizures in older persons (60 years of age).
Methodology: A cross- sectional study was conducted in a tertiary care hospital in the eastern part of India after getting institutional ethics committee (IEC) approval. Seventy five cases of both sexes and of age  60yrs admitted with new-onset seizure were included. All patients underwent detailed history, clinical evaluation and relevant investigations. Etiology and clinical profile of new-onset seizure were studied. Classification of seizure was done as per ILAE classification 1981/1989. According to age, participants were grouped to 5 categories: 60-64yrs, 70-74yrs, 75-79yrs and  80yrs.
Results: Out of 75 patients, 44 (58.6%) were males and 31 (41.3%) were females with mean age of 67.94yrs (+6.41SD). Majority of patients were in the age group of 60-64yrs (41.3%). 46 (61.3%) patients had co-morbid conditions of hypertension, diabetes mellitus and both hypertension & diabetes mellitus in 26.6%, 20% and 14.6% cases respectively. Stroke was most common etiology observed 41.3% cases, followed by metabolic causes in 18.66% cases, alcohol withdrawal in 10.6% cases, brain tumor in 8% cases, head trauma in 5.3% cases, CNS infection in 2.66% & Idiopathic (cryptogenic) in 13.3% of cases. Ischaemic stroke was commoner than hemorrhagic stroke (26.6% vs 12%). Hyponatremia was observed in 13.3% cases & all cases of CNS infection were of bacterial meningitis. Most common type of seizure was partial seizure observed in 61.3% cases followed by Generalised Tonic Clonic seizure in 22.6% cases & Status epilepticus in 16% cases. Complex partial seizure observed in 30.6% cases was the commonest type of partial seizure. Partial seizure with secondarily generalization was the least common type of seizure noticed in 13.3% cases. Most common etiology of generalised tonic clonic seizure was ischaemic stroke & alcohol withdrawal. 57% of all metabolic seizure were of partial seizure with secondarily generalisation type. Maximum percentage of idiopathic seizures were of Complex partial & Status epilepticus type. EEG abnormality was observed in 61% cases with focal eplileptiform discharge being the prominent finding. Abnormal findings on CT scan of brain were noticed in 66.2% cases with cerebral Infarction in 24% cases.
Conclusions: In the present research, stroke was the most often seen cause of seizures among the study group, with metabolic derangement coming in second. Ischaemic stroke causes more elderly new-onset seizures than hemorrhagic stroke. The most common type of seizure found in the elderly was complex partial seizures. In the elderly, hyponatremia was the most common type of metabolic injury that resulted in seizures.