Characteristics and treatment of midlife-onset epilepsy: A 24-year single-center, retrospective study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY Epileptic Disorders Pub Date : 2024-06-19 DOI:10.1002/epd2.20253

Xu Zhang, Feng Xiang, Xiaobing Shi, Ziyu Wang, Yang Li, Shimin Zhang, Xiaoyang Lan, Senyang Lang, Xiangqing Wang

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Abstract

Objective

This study aimed to analyze the clinical characteristics, etiology, and treatment of midlife-onset epilepsy in a real-world setting at a single center in China.

Methods

The clinical data of patients who attended the epilepsy clinic of the Department of Neurology, First Medical Center of Chinese PLA General Hospital from February 1999 to March 2023 were retrospectively analyzed. The clinical characteristics, etiology, and risk factors for midlife-onset epilepsy over the past 24 years were analyzed.

Results

Of the 969 patients with onset at 45–64 years of age, 914 were diagnosed with epilepsy with at least two unprovoked seizures 24 h apart. Of those, 99.7% (911) were of focal origin. The median duration from the initial seizure to follow-up treatment was 2 months (interquartile range [IQR]: 1.0–6.0 months). Before commencing treatment, 30.2% (207/683) of patients experienced more than two seizures. A structural etiology was found in 66.3% (606/914) of patients. Cerebrovascular disease (CVD) and traumatic brain injury (TBI) accounted for 19.9% (182/914) and 16.6% (152/914) of the cases, respectively. Logistic regression analysis showed that patients with abnormal imaging (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.25–3.32; p = .004), focal seizures (OR 2.98; 95%CI 1.82–4.87; p < .001), and seizure clusters (OR 2.40; 95%CI 1.21–4.73; p = .01) had poor drug responses. Treatment outcomes were generally better in patients with epilepsy after CVD (OR .49; 95%CI .28–.85; p = .01). Treatment initiation after two seizures (OR .70; 95%CI .42–1.15; p = .16) or 6 months after the first seizure (OR 1.17; 95%CI .66–2.09; p = .58) did not result in poor drug effectiveness.

Significance

Midlife-onset epilepsy is typically of focal etiology, with CVD being the most common cause, and tends to respond well to medication. The median duration from the initial seizure to follow-up treatment was 2 months. Over 30% of patients experienced more than two seizures before commencing treatment, but this did not affect subsequent outcomes.

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中年癫痫的特征和治疗：一项为期 24 年的单中心回顾性研究。

研究目的本研究旨在分析中国单个中心中年癫痫的临床特点、病因和治疗方法：方法：回顾性分析1999年2月至2023年3月在中国人民解放军总医院第一医学中心神经内科癫痫门诊就诊患者的临床资料。分析了过去24年中年癫痫的临床特征、病因和危险因素：在 969 名 45-64 岁发病的患者中，有 914 人被诊断为癫痫，且至少有两次无诱因癫痫发作相隔 24 小时。其中，99.7%（911 人）为局灶性癫痫。从首次癫痫发作到后续治疗的中位时间为 2 个月（四分位数间距 [IQR]：1.0-6.0 个月）。在开始治疗前，30.2%（207/683）的患者经历过两次以上的癫痫发作。66.3%的患者（606/914）找到了结构性病因。脑血管疾病（CVD）和脑外伤（TBI）分别占 19.9%（182/914）和 16.6%（152/914）。逻辑回归分析显示，影像学异常（几率比 [OR] 2.04；95% 置信区间 [CI]1.25-3.32；P = .004）、局灶性癫痫发作（OR 2.98；95%CI 1.82-4.87；P 意义重大：中年期发病的癫痫通常是局灶性病因，心血管疾病是最常见的病因，而且往往对药物治疗反应良好。从首次发作到后续治疗的中位持续时间为 2 个月。超过30%的患者在开始治疗前经历了两次以上的癫痫发作，但这并不影响后续治疗效果。

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来源期刊

Epileptic Disorders 医学-临床神经学

CiteScore

4.10

自引率

8.70%

发文量

138

审稿时长

6-12 weeks

期刊介绍： Epileptic Disorders is the leading forum where all experts and medical studentswho wish to improve their understanding of epilepsy and related disorders can share practical experiences surrounding diagnosis and care, natural history, and management of seizures. Epileptic Disorders is the official E-journal of the International League Against Epilepsy for educational communication. As the journal celebrates its 20th anniversary, it will now be available only as an online version. Its mission is to create educational links between epileptologists and other health professionals in clinical practice and scientists or physicians in research-based institutions. This change is accompanied by an increase in the number of issues per year, from 4 to 6, to ensure regular diffusion of recently published material (high quality Review and Seminar in Epileptology papers; Original Research articles or Case reports of educational value; MultiMedia Teaching Material), to serve the global medical community that cares for those affected by epilepsy.