Does age influence diagnostic outcomes in an adult cohort referred to a first‐seizure clinic?

OBJECTIVE: The aging Danish population is associated with increasing morbidity and healthcare utilization. This study examines age-related differences in resource utilization and diagnostic outcomes between older (65-95 years) and younger adults (18-64 years) evaluated for suspected epilepsy, including clinical management, diagnostic yield, and final diagnoses. METHODS: This single-center retrospective cohort study used electronic health record registry data from adults referred for epilepsy evaluation at Aalborg University Hospital between April 1, 2022, and January 8, 2024, with 1-year follow-up. Patients were stratified into different age groups and the relative risk (RR) of receiving an epilepsy diagnosis was modeled using a modified Poisson regression method, with age as the primary predictor. The diagnostic yield of magnetic resonance/computed tomography (MR/CT) and the sensitivity and specificity of electroencephalography (EEG) were compared using the chi-square test and Fisher's exact test. RESULTS: Of 530 patients evaluated, 30% received an epilepsy diagnosis and 17% were diagnosed with a first unprovoked seizure. International Classification of Diseases, 10th Revision (ICD-10) codes varied with age, and the RR for epilepsy was significantly higher in older adults 65-95 years of age compared with both adults 18-64 years of age and those 40-64 years of age. This association remained unchanged after adjustment for sex. Furthermore, 97.7% underwent neuroimaging, and 92.6% underwent an EEG. The diagnostic yield of EEG and neuroimaging (magnetic resonance imaging [MRI] and CT) did not differ significantly between the two age groups. SIGNIFICANCE: Older adults referred for epilepsy evaluation were more likely to receive an epilepsy diagnosis. More than half of patients initially thought to have epilepsy, or a first unprovoked seizure, were ultimately assigned a diagnosis other than epilepsy after comprehensive clinical assessment. These findings underscore the importance of careful, age-sensitive diagnostic evaluation, and highlight the need for further research to elucidate age-related diagnostic patterns and refine inclusion criteria and workup strategies in first-seizure clinics.