Objective:

This study aimed to compare the clinical profiles and causes of epilepsy in older patients (age > 60 years) with those in a younger cohort (age ≤ 60 years).

Background:

Epilepsy is the third most common neurological disorder in older adults, with an incidence and prevalence of 2.41/1,000 and 10.8/1,000 in the elderly, respectively.

Design/Methods:

We retrospectively reviewed the electronic records of 2,975 epilepsy patients (654 elderly vs. 2,321 younger patients) from 2014 to 2024 at our tertiary centers. The 2017 ILAE Classification was used to categorize seizures and epilepsy.

Results:

Among the elderly group, 240 (36.7%) had seizure onset at or before 60 years of age. Compared to elderly patients, younger patients had more developmental disabilities (15.3% vs. 3.8%, p < 0.001), learning disabilities (15.2% vs. 4.1%, p < 0.001), aura (14.3% vs. 11.5%, p = 0.119), and generalized epilepsy (29.7% vs. 13.8%, p < 0.001). The elderly group had more focal epilepsy (59.9% vs. 43.9%, p < 0.001), unclassified epilepsy (20.6% vs. 14.9%, p < 0.001), and epilepsy with no obvious etiology (56.7% vs. 49.0%, p < 0.001). Structural causes were observed in 66 (10.1%) elderly patients and 135 (5.8%) younger patients (p < 0.001), with stroke (39.3%) and tumors (27.3%) being the most common causes in the elderly group. Abnormal EEGs were found in 65 (19.2%) and 300 (24.5%) elderly and younger patients, respectively (p = 0.057). Background slowing and asymmetric slowing were more common in the elderly group than in the younger group (68.4% vs. 31.6%, p < 0.001, and 56.2% vs. 43.8%, p = 0.035, respectively). Epileptiform discharges were more common in the younger group (84.5% vs 15.5%, p < 0.001).

Conclusions:

This study highlights differences in the subtypes of epilepsy, etiology, and EEG findings based on the age of epilepsy onset.