A Study on New Onset Seizures in Age Group more than 40 Years

Balaji, G (2007) A Study on New Onset Seizures in Age Group more than 40 Years. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Seizures have been recognized since antiquity. One of the earliest descriptions1 of a secondarily generalized tonic-clonic seizure was recorded over 3000 years ago in Mesopotamia, which was attributed to the god of the moon. Epileptic seizures were described in ancient cultures including those of China, Egypt, and India. The word seizure is derived from Latin word "sacire", meaning, "to take possession of" indicating that the person having a seizure is possessed or atleast out of control2 . The clinical symptoms in seizures could be motor, sensory, autonomic, or psychic events although in practice, when a patient presents to a health care system with a seizure it is usually a convulsive (motor) seizure, either generalized or focal. Cumulative observations of many clinical investigators, along with adjunctive neurophysiological, imaging and genetic tools created a well-accepted diversity in the etiologies of seizures in various age groups.Interstingly, the highest incidence of seizures occur in early childhood and late adulthood. In older adults and elderly the frequent causes are cerebrovascular disease, brain tumors , alcohol withdrawal , metabolic disorders , degenerative diseases and idiopathic3. With aging population growing in our nation, thanks to improved medical infrastructure, a growing number of elderly people will be seeking attention to our health care system. This study is to analyze the seizures occurring in age the group of more than 40 years. AIM OF THE STUDY: 1. To study the etiologic profiles of first onset seizures in patients aged more than 40 years of age. 2. To analyze the age / sex distribution, presenting history, clinical findings and investigations at admission in the study group. MATERIALS AND METHODS The study was done in the setting of the Institute of Internal Medicine, Government General Hospital, Chennai. The study had collaborations with the Institutes of Neurology, Biochemistry, Pathology, Radiology and Microbiology. The study was observational in nature designed to analyze patients in age group more than 40 years of age and who presented with first onset seizures. The sample size was 68 and the study period was from July 2005 to June 2006. INCLUSION CRITERIA: • Patients who presented with first onset seizures over the age of 40 years admitted in our medical unit. • Inpatients who developed first seizure in this hospital. • Time between seizure and presentation to us within 15 days. EXCLUSION CRITERIA: • History of trauma • History of ingestion of toxins. SUMMARY: The first step in evaluation of a presumed seizure is to determine whether the event was indeed a seizure and which diagnostic studies are needed. The second step is to correctly diagnose the seizure on the basis of the medical history and findings from the physical, neurologic, and laboratory evaluation. The third step is to decide whether drug treatment is necessary. Every paroxsymal event is unique, and not every seizure needs to be treated. When treatment is deemed appropriate, an antiepileptic drug should be chosen after consideration of the risk-benefit profile of the available agents. RESULTS • The mean age of patients in the commonly encountered etiologies, in the study was around sixty years. • The mean age of granulomatous etiology, was the least in this study. • Generalized seizures (71%) were the most common seizure type encountered in the study. • Limb weakness and headache were among the most common nonconvulsive presenting symptom. • In the clinical examination, motor system abnormality was the most consistent factor that predicted an abnormal CT scan. • EEG, which was done in 57% of the patients in the study recorded abnormalities in 46%. • Cerebrovascular accidents were the most frequent etiology for the first onset seizure after forty years of age in this study. • Literature reveals a great diversity in the proportions of tumors forming etiology of seizures in later ages (1% to 36%). This study established tumors as etiology in 16% of patients. • CVA, tumors, metabolic causes and alcohol withdrawal formed 80% of the etiology of seizures. • In this study, 11%(eight patients) mandated neuro-surgical intervention. • Metabolic abnormalities contributed to etiology in 13% of patients. • CT detected abnormal lesions in 42% of cases. • MRI was instrumental in uncovering new lesions in nine patients. • In this study, causes could not be identified for 13% of the patients. CONCLUSIONS: • Unlike in young, most of the seizures in the age group studied, had their etiologies established. Hence, in a patient with new onset seizures more than 40 years, all efforts to identify the etiology should be made. • Given the age of patients with a seizure more than forty years does not exceedingly favor any specific etiology. • Thorough search to rule out metabolic factors as cause seizures should be an early priority. • CT brain and MRI are indispensable in patients more than 40 years with new onset seizures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: New Onset Seizures ; Age Group more than 40 Years.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 28 Mar 2018 03:34
Last Modified: 30 Mar 2018 15:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/6638

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