For People With Seizures, It May Be Better to Be Old

 Don't let your doctor use this excuse in not preventing seizures post stroke!

Let's see how long your doctor has known of the problem and HASN'T SOLVED IT!

We've known of this problem a long time. Provide solutions you blithering idiots!

• 10% seizures post stroke (19 posts to April 2017)

• 5% epileptic seizures after stroke (10 posts to April 2021)

• epileptic seizures (6 posts to December 2015)

• post-stroke epilepsy (17 posts to December 2016)

For People With Seizures, It May Be Better to Be Old

ATLANTA -- In health matters it's not often that older people do better than their younger peers, but seizure disorders may be an example, suggested a cross-sectional study.

Liverpool Seizure Severity Scale (LSSS) scores, which are based on patients' self-evaluations of their seizure experiences both during and immediately after, were negatively correlated with increasing age, according to Negin Badihian, MD, of the Cleveland Clinic -- meaning that older age was associated with less overall severity. The study was conducted among more than 8,000 patients seen at the clinic from 2007 through early 2025.

Examining individual items on the LSSS questionnaire indicated that nearly all were less severe in older patients, she reported at the American Epilepsy Society annual meeting. During the ictal phase itself, greater age was associated with shorter duration, less loss of consciousness and falling, and less automotor behaviors such as lip smacking and fidgeting. Afterward, such issues as headache and confusion frequency were less severe with increasing age.

Only two of the scale's 12 items didn't correlate with age: incontinence and confusion duration.

Also surprising was that a greater comorbidity burden had relatively little impact on LSSS scores. It did correlate with greater probability of incontinence, but also with less automotor behavior, Badihian reported.

At the Cleveland Clinic's epilepsy unit, patients complete the LSSS during outpatient visits. The LSSS items are structured as statements about their seizures in general and specific common effects, which patients complete by rating the item's severity. For example,"I feel that my most severe seizures have mostly been..." followed by options ranging from "very severe" to "very mild." Other items cover loss of consciousness, falling, confusion, urinary incontinence, tongue biting, other injuries, post-seizure somnolence, headache, and time to recover full cognition. Most items refer specifically to the person's most severe seizure. Scores range from 0 to 100, increasing with greater severity.

Badihian and colleagues took account of numerous factors in analyzing the data: sex, race, epilepsy type (focal or generalized) and duration, frequency over the previous 4 weeks, whether they had undergone surgery for the seizures, use of anti-seizure medications, and area deprivation index (ADI) for the patient's residence. Analyses were performed on the raw data without adjustment, with adjustments excepting epilepsy duration, and with adjustments for all the listed factors including epilepsy duration.

In that fully adjusted model, the following significant correlations were found:

• Age: -2.69 LSSS points per 10 years
• Male sex: -2.48 points
• Black race: 2.92 points
• ADI national rank: 1.36 points per 10 units
• Seizure frequency: -5.35 points for ≥11 vs 1
• Epilepsy surgery history: -6.89 points

On the other hand, comorbidity burden, as expressed in the Charlson Comorbidity Index, did not correlate with overall LSSS scores, with an increase in 5 units associated with just a -0.10 change (P=0.91). The 10 items other than incontinence and automotor signs all appeared indifferent to comorbidity burden.

"These findings highlight the impacts of aging and comorbidities on seizure-related features," Badihian said, "which are important for patient counseling and management."

Study limitations included the long time period covered in the study, during which the treatment landscape has changed considerably. As a retrospective analysis, unmeasured confounders could have influenced the results. The study also relied on ICD-9/10 codes in patients' records for comorbidity counts, and was conducted among patients seen at one clinic.