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. 1998 Mar 7;316(7133):780. doi: 10.1136/bmj.316.7133.780

Incidence of epilepsy is now higher in elderly people than children

Alex D Everitt 1, Josemir W Sander 1
PMCID: PMC1112742  PMID: 9529433

Editor—We were surprised by Neville’s statement, in his review on epilepsy in childhood, that “epilepsy starts in childhood in 60% of cases.”1 Although this was possibly the case more than 20 years ago, recent evidence suggests otherwise.

The United Kingdom national general practice study of epilepsy, a prospective population based study, found that in 564 definite incident cases recruited between 1984 and 1987, only 25% of patients were aged under 15.2 Furthermore, while children undoubtedly have the highest incidence of epilepsy among people aged under 65, strong evidence has emerged that seems to confirm a recent secular trend in the age specific incidence of epilepsy, with a decline in incidence in children and a shift towards elderly people.35 The incidence of epilepsy in the elderly population, at least in community based studies from developed countries, is now frequently reported as being between 100 and 140 per 100 0003,5 (and possibly much higher in subjects over 80 years old), which is far greater than the overall incidence of epilepsy.3,5

No clear explanation for these changes has emerged, though several factors are probably involved. It has been suggested that improvements in medical antenatal and perinatal care, coupled with increased awareness of the necessity for expectant mothers to adopt healthier lifestyles, may have played a part in the decline in the incidence of childhood epilepsy by way of decreases in the incidence of malformations of cortical development and birth hypoxia, but this remains speculative.3 Among elderly people, increased life expectancy has inevitably led to a larger population at risk; elderly people are anyway susceptible to cerebrovascular disease, which is by far the commonest cause of seizures in this age group.3,5 Although the incidence of overt cerebrovascular disease has paradoxically decreased in the community over the past two decades,5 it is possible that small vessel cerebrovascular disease in subjects with newly diagnosed seizures who are otherwise asymptomatic may be responsible for this discrepancy. Population based studies of epilepsy that apply high resolution magnetic resonance imaging to incident cases in all age groups will help resolve some of these issues.

References

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