Objective:

Determine the comparative delay from initial seizure presentation to epilepsy diagnosis in older adults and evaluate how EEG and MRI utilization impacts this delay.

Background:

New-onset epilepsy is common among older adults, but diagnosis may be delayed due to atypical seizure presentations. Early recognition of epilepsy is critical since prompt initiation of treatment improves outcomes. Prior studies have identified delays in diagnosis ranging from eight to twenty months, but the extent of diagnostic delay has not been explored in a large, nationwide cohort.

Design/Methods:

Persons with epilepsy treated at the Veterans Health Administration were retrospectively identified using validated criteria. The initial seizure presentation was determined by searching for seizure and its mimics in the five years preceding official epilepsy diagnosis. Patients not initially diagnosed with a seizure (either convulsions or epilepsy) were considered for analysis. EEG and MRI data were collected. Delays were compared by age group using the Wilcoxon rank-sum test, and associations with EEG/MRI workup were explored via quantile regression.

Results:

Patients were grouped as young (age 18-64y, N=30,622, 13.9% female) and late onset epilepsy (age 65y+, N=35,570, 3.2% female). Median diagnostic delay was 12.5 months among late onset epilepsy, which was longer than the median delay of 9.7 months among young onset epilepsy (W=5.1e+08, p<0.001). Utilization of EEG or MRI within six months of presentation was associated with decreased delay. This effect was age-dependent; EEG or MRI workup reduced the delay by 7.3 months in young (p<0.001) and 11.4 months in late onset epilepsy (p<0.001).

Conclusions:

These findings highlight the importance of considering epilepsy in older adults with seizure-like episodes and indicate that early EEG or MRI utilization shortens diagnostic delay. This study analyzed administrative data, so identification of initial seizure presentation may have been inaccurate for some patients. Future prospective studies could further assess diagnostic processes for areas of improvement.