Management and outcomes among older adults with generalized epilepsy in routine clinical practice

Generalized epilepsy is classically thought of as a disease of the young and adolescent, with rarely reported cases among older adults. We aimed to analyze management and outcomes in a population sparsely described in the literature through a retrospective single-center cohort design. After excluding individuals without follow-up, we identified 151 people ≥50 years at the time of electrographically confirmed generalized epilepsy. Just over a quarter were late-onset (≥26 years), and 77% were diagnosed with genetic generalized epilepsy (GGE). Active seizures (in the last year of follow-up) were present in 57% of individuals, despite most of them having experienced prolonged seizure remission periods (median 7 years) in the past. Only five people were off antiseizure medication (ASM) at their last appointment, with most on an average of 2 ASMs. The odds of active epilepsy at the last follow-up were significantly higher among those with polyspikes (odds ratio [OR] = 2.42; 95% confidence interval [CI] = 1.01-6.01), myoclonic seizure history (OR = 2.88, 1.23-6.96), and developmental delay (OR = 4.75, 1.45-19.3). The odds were 60% lower in older adults with family history (OR = 0.4, 0.17-5.68). Our findings suggest that most older adults with generalized epilepsy achieve years of seizure remission, but the likelihood of epilepsy resolution is low. PLAIN LANGUAGE SUMMARY: Generalized epilepsy is seldom seen in older adults. We looked at 151 patients diagnosed with generalized epilepsy over the age of 50 to see how they are managed and what influences their outcomes. We found that although these patients can control their seizures with medication, the chance that their epilepsy resolves is low. Patients with certain characteristics classically seen in an epilepsy called "Juvenile Myoclonic Epilepsy" (JME) may have a more intractable course.