Epidemiology and Management of Late-Onset Epilepsy

Late-onset epilepsy, defined by seizure onset after the age of 60, has emerged as a significant contributor to neurological morbidity in ageing populations. Incidence rates vary globally but consistently rise with advancing age, reflecting the burden of cerebrovascular disease, neurodegenerative disorders and brain tumours in older adults. Epidemiological studies highlight a twofold to threefold higher incidence of epilepsy in those over 65 compared with younger cohorts, with structural aetiologies such as stroke accounting for up to half of new diagnoses. Management challenges in this demographic include comorbidity profiles, polypharmacy risk and age-related pharmacokinetic changes. Contemporary treatment paradigms emphasise personalized selection of antiepileptic drugs to balance efficacy, tolerability and drug–drug interactions, while addressing cognitive and psychosocial sequelae. Diagnostic work-up increasingly combines high-resolution MRI, prolonged electroencephalography and cerebrospinal fluid biomarker analysis to reveal underlying causes and guide prognosis. Preventive strategies targeting modifiable vascular risk factors have been proposed to mitigate both seizure recurrence and dementia risk. Multidisciplinary care pathways and geriatric neurology services are being advocated to optimise outcomes, reduce hospital admissions and support quality of life in this growing patient population.

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Epidemiology and Management of Late-Onset Epilepsy publication trend

The graph below shows the total number of articles in epidemiology and management of late-onset epilepsy across all publications each year (not limited to Nature Index journals).

Technical terms

Late-Onset Epilepsy (LOE): Epileptic seizures commencing at or after the age of 60.

Antiepileptic drugs (AEDs): Medications prescribed to prevent or reduce the frequency of seizures.

Focal epilepsy: Seizure activity originating within a restricted region of the cerebral cortex.

Mild Cognitive Impairment (MCI): A stage between expected cognitive ageing and dementia characterised by subtle deficits.

Electroencephalography (EEG): A non-invasive technique for recording brain electrical activity to identify epileptiform discharges.

Hippocampal atrophy: Reduction in hippocampal volume, often associated with seizure-related neuronal loss and cognitive decline.

References

1. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurology (2023).
2. Clinical and Instrumental Characterization of Patients With Late-Onset Epilepsy. Frontiers in Neurology (2022).
3. Trends in prescribing patterns of antiepileptic drugs among older adult inpatients in a Brazilian tertiary center. Arquivos de Neuro-Psiquiatria (2021).