Clinical, neurophysiological, and radiological correlates of treatment response in elderly patients with epilepsy

Background: Epilepsy in elderly patients presents unique diagnostic and therapeutic challenges, with variable clinical, neuroimaging, and electroencephalographic (EEG) features. Understanding these complexities is crucial for optimizing management strategies in this growing population. Objective: To characterize the clinical, neuroimaging, and EEG features of elderly-onset epilepsy and to evaluate their association with seizure control and treatment response. Methods: We retrospectively evaluated 37 epilepsy cases with seizure onset after 65-years-old who had been followed up at a tertiary care center between January 2019 and January 2023. Clinical characteristics, EEG and magnetic resonance imaging (MRI) findings, seizure types, treatment responses, and comorbidities were systematically analyzed. Seizure syndromes were classified according to International League Against Epilepsy (ILAE) criteria. Results: Structural focal and unknown etiology epilepsy were the most common subtypes. Seizure remission for at least 36 consecutive months was achieved in 81.1% of patients, with 64.9% responding to first-line antiseizure therapy. The MRI scan revealed epileptogenic lesions in 40.5% of patients; however, no statistically significant association was found between neuroimaging findings and treatment outcomes. Some EEG abnormalities were noted, including epileptiform discharges (24.3%) and background slowing (24.3%), but no statistically significant association was found with seizure control. Convulsive status epilepticus occurred in 10.8% of patients but was generally well-managed. Psychiatric comorbidities were encountered less frequently compared with younger populations. Conclusion: Comprehensive clinical assessment, supported by neurophysiological and radiological findings, may help optimize the diagnosis and effective management of epilepsy in elderly patients.