Epilepsy after the age of 50

Abstract

Ninety-three patients with seizures starting when the patients were 50 years old or more were reviewed, and follow-up studies were conducted on 80 of these patients. Of these 80, 29 had intracranial tumors. All those with primary cerebral tumors had some focal feature, either clinical seizure type, neurological sign, or electroencephalographic abnormality, though 5 had initially negative contrast studies. Of 29 patients with cerebral tumors, 22 had electroencephalographic changes suggestive of destructive lesions. Fifty-one patients showed no evidence of cerebral tumor after a follow-up study of at least five years or at death. Twenty of these patients were atherosclerotic, 10 had seizures associated with a variety of known diseases, and 21 had no obvious cause for seizures. In many of the nontumor group, the seizures were chiefly nocturnal, easily controlled by anticonvulsants and not a major problem to the patients. Approximately one-third of the patients whose cases were followed up were found to have cerebral tumors. Therefore, it appears that the majority of patients who present with cerebral seizures only for the first time over the age of 50 do not have cerebral tumors. Of these, a large proportion were atherosclerotic, and others had miscellaneous diseases associated with their seizures. No definite cause was determined for the remaining 25% of the total number of patients followed, despite careful analysis of their case records and at least a five-year follow-up study.