The Clinical Characteristics And Treatment Of Elderly Patients With Epilepsy In West China

Objective:The aim of this study is to identify the clinical characteristics and treatment of elderly patients with epilepsy in west china.Methods:From January 2010 to January 2015,the clinical data of elderly patients with epilepsy were consecutively recorded from Sichua provincial peolpe's hospital,First affiliated hospital of Chongqing medical university,and West China Hospital.The information were analyzed statistically according to social-demographic data,age,living area,the age of first seizure,seizure type,etiology and anti-epileptic therapy etc.Results:1.The present study examined 794 patients of elderly patients with epilepsy,Among these patients,450(56.7%)were diagnosed with partial seizure and secondary generalized tonic-clonic seizure,211(26.6%)with generalized seizure,133(16.8%)with unclassified seizure.505(63.6%)of them were confirmed as symptomatic.289(36.4%)were confirmed as idopathic/cryptogenic.According to known etiology,ischemic stroke was identified in 167cases(33.1%),followed by brain injury in 83cases(16.4),metabolic/toxic disease in 57 cases(11.3%),hemorrhage stroke in 47 cases(9.7%),brain tumor in 46 cases(9.1%),dementia in 33 cases(6.6%),CNS infection in 18 cases(3.6%),others in 54cases(10.7%)?2.There were significant differences in the constituent ratio of etiology by age and living area.Brain injury,metabolic/toxic disease and CNS infection were common in age younger than 75 years group,stroke and dementia were more common in age over 75 years group.Brain injury and CNS infection were more common in rural patients,stroke and dementia were also more common in urban patients.3.Among all study population,634(79.8%)were accepted monotherapy,29(3.7%)were accepted combined two or more AEDs,11(1.4)were accepted TCM,120(15.1%)were accepted no anti-epileptic therapy.Of the 634 cases,VPA and TPM were the most common AEDs(30.6%and 17.7%,respectively),followed by LEV(17.7%),OXC(12.5%),LTG(8.8%),CBZ(5.5%),PHT(5.2%),PB(1.1%)and GBP(0.9%).TPM and VPA were the most common AEDs for partial seizure(26.4%and 23.5%,respectively),followed by OXC(14.3%),LEV(8.9%),PHT(8.1%),LTG(7.8%),CBZ(7.5%),PB(1.9%)and GBP(1.6%);VPA and LEV were the most common AEDs for generalized seizure(41.5%and 24.4%,respectively),followed by LTG(15.2%),TPM(7,9%),OXC(7.9%),CBZ(1.8%)and PHT(1.2%);VPA and LEV were the most common AEDs for generalized seizure(39.4%respectively),followed by OXC(13.1%),CBZ(4.0%),LTG(2%),TPM(1%)and PHT(1%)?Conclusion:1.Sixty three point six percentage of elderly patients were confirmed as symptomatic in west china,and was symptomatic epilepsy was more common in age over 75 years group;2.Stroke and brain injury were the most common etiology of elderly patients in west china(42.4%and 16.4%respectively),followed by brain injury(16.4%),metabolic/toxic disease(11.3%),hemorrhage stroke(9.7%),brain tumor(9.1%),dementia(6.6%),CNS infection(3.6%),and the others(10.7%).3.Sixteen point four percentage of patients were confirmed brain injury as underlying cause,simultaneously post-stroke epilepsy was more common in younger than 75 years group and rural patients(20.3%and 24.9%,respectively)which may attribute to the surroundings and economy.4.Majority of elderly patients accepted appropriate anti-epileptic therapy,the treatment gap was lower than other study.Monotherapy was the most common in all seizure types,which may attribute to improvement of health care and advanced training for the physician.5.The choice of anti-epileptic drug in the elderly patients was in accordance with guideline,valproic acid was widely utilized to treat elderly epilepsy in mainland China.Topiramate was the most common used AEDs for partial seizure which may be due to experts' experience.