SAN DIEGO — Seizures in elderly patients may present as subtle changes or unexplained fluctuations in cognitive abilities, results from a small study demonstrated.
The finding suggests that physicians “need to consider subtle or subclinical seizures in the differential diagnosis of cognitive deficits in the elderly,” researchers led by Dr. Eliot A. Licht wrote in a poster presented at the annual meeting of the American Neuropyschiatric Association. “Epilepsy is a potentially reversible cause of dementia.”
In an interview, Dr. Licht, of the department of neurology at the Veterans Affairs (VA) Greater Los Angeles Healthcare System, said the finding “introduces another possible treatment intervention for patients who might otherwise be receiving standard cholinesterase inhibitor therapy.”
Over a period of 6 months, he and his associates identified six patients aged 64–83 years who presented to the VA's memory disorders program for an evaluation of dementia. All patients underwent clinical examinations for seizure activity and received standard awake and drowsy electroencephalograms (EEGs). One of the six was known to have epilepsy.
EEGs showed recurrent epileptiform activity in all six patients. “This is not to say that in every case the epileptiform activity was causing all of their cognitive deficits, but it's possible that it was contributing to it,” Dr. Licht said.
Risk factors for seizures included stroke or ischemic changes, history of tumor, and history of electroconvulsive therapy.
In their poster, the researchers discussed the case of one patient who was admitted for dementia with aggressive behavior, but who did not show clinical seizures at that time. “Following add-on therapy with valproic acid, his epileptiform activity ended and his [Mini Mental State Examination] score of 20/30 improved to 30/30,” they wrote.
“Sometimes you may need to do more than one study to get an idea of what's going on in terms of the fluctuations,” Dr. Licht said. “That is, on day 1 someone may come in and have a small amount of activity that's not too common. But on day 10 [the activity] may be much more common.”