#7125 Dissociative seizures in older adults

<h3>Objective</h3> To study the demographic profile and clinicopathological correlates of late onset dissociative seizures (DS) in older adults. <h3>Background</h3> DS are more common in young adults, with the typical age of onset between 20 yrs and 40 yrs. There is paucity of literature examining DS in older adults with onset later in life. <h3>Methods</h3> This is a retrospective study of older adults, 60 yrs or above, admitted to the Scottish Epilepsy Centre (SEC) from 1^stJan 2012 to 31^stDec 2023 who received a diagnosis of DS. Patients’ case notes were reviewed to collect data on demographics, background history, clinical features, medications, investigations, acceptance of diagnosis and presentation at the latest follow up upon discharge. <h3>Results</h3> 20 patients were diagnosed with DS during the study period with the age on admission to SEC ranging from 60 yrs 9 months to 82 yr 6 months. Median age of onset of seizures was 58 years with the mean duration of undiagnosed DS of 7.9 years. Four patients had co-morbid epilepsy and 5 patients had intellectual disability. 13 patients had history of mental illness; anxiety and depression being the most common diagnosis. The number of patients on psychotropics at admission and discharge were 12. None of the patients reported a family history of epilepsy. Physical health problems were noted to be the most common precipitating factors; history of stroke in 5 patients. Death of a loved one or loss were noted to be second most common precipitating factors for DS in this patient cohort. Only 3 patients reported traumatic childhood experiences. Video Telemetry was undertaken in 12 cases for diagnostic clarity and most patients accepted the diagnosis of DS. Neuroimaging (CT/MRI) was reported to be normal only in 4 cases. Tremulous seizures were most common with 4 cases presenting with an emotional component of attack. Half of the patients expressed concerns about cognition on admission. Scores on objective scales for cognition and mood improved following withdrawal of antiepileptic drugs. Most patients continued to do well with better quality of life on follow with only three patients presenting to services later with overall deterioration and worsening attacks. <h3>Conclusion</h3> DS can arise later in life often precipitated by psychological trauma of deteriorating physical health and loss. Correct diagnosis, brief psychological interventions to help understand and come to terms with the diagnosis and rationalizing medications can significantly improve the outcome and quality of life in this cohort of patients.