To analyze clinical features and management of elderly (≥60 years of age) individuals with generalized epilepsy undergoing epilepsy monitoring unit (EMU) evaluation.

Generalized epilepsy is most commonly seen in children, adolescents and young adults with well characterized clinical characteristics and management. Despite rapidly aging population, not much is known about generalized epilepsy in the elderly population. We aim to fill this knowledge gap.

We performed a single-center, cohort study. Patient ≥60 years of age at time of EMU admission who were diagnosed with generalized epilepsy (based on EEG findings) were included in the study. Data on seizure onset age, management and seizure types were extracted from chart review. We used medians and quartiles (interquartile range (IQR =first - third quartiles) or mean and standard deviation (SD) for continuous variables, depending on distribution. Fisher exact test was performed to compare patients with late-onset (≥50 years of age) epilepsy to the rest of population.

A total of 30 elderly individuals, including 19 (63.3%) females, with the mean age of 67.6 (SD = 6.5) years were included in the study. The median age of epilepsy onset was 16 (IQR = 6 – 56) years. One-third (n = 10) patients had late onset of epilepsy. The indication of EMU evaluation was diagnosis or characterization of spells in 17 (56.7%) and seizure burden assessment in the rest. Four (13.3%) patients had never been on ASMs and 20 (66.6%) had refractory epilepsy. Generalized tonic-clonic (GTC) seizures were experienced by 19 out of 20 (95%) compared to 6 (60%) late onset patients (p = 0.03).

A substantial proportion of elderly patients with generalized epilepsy evaluated in EMU have late-onset epilepsy, which differs in seizure type from the early-onset population. Further study of generalized epilepsy in non-EMU population is warranted.