Etiological Spectrum and Clinical Outcomes of Epilepsy in the Geriatric Population of Western Uttar Pradesh: A Prospective Observational Study

Dr. Sanjay Sharma M. Dr. Garima Chaudhary, Dr. Ojasvi Vats

Abstract

Background: Epilepsy shows a bimodal age distribution, with a second incidence peak in individuals ≥60 years [1,2]. The elderly constitute the fastest-growing subgroup of epilepsy patients globally [3]. Regional Indian data remain limited.

Objective: To evaluate etiological spectrum, clinical characteristics, and predictors of outcome in geriatric epilepsy in Western Uttar Pradesh.

Methods: A prospective observational study (January 2023–December 2024) including patients aged ≥60 years with ≥2 unprovoked seizures. Seizures were classified according to ILAE 2017 criteria [4,5]. Clinical, EEG, metabolic, and neuroimaging data were analyzed. Logistic regression identified predictors of poor outcome (mRS ≥3 at 12 months).

Results: Among 300 patients (mean age 68.4 ± 6.5 years; 56% male), focal-onset seizures predominated (66%). Etiology included cerebrovascular disease (38%), neurodegenerative disorders (21%), metabolic abnormalities (15%), intracranial space-occupying lesions (12%), infections (6%), and cryptogenic causes (8%). EEG abnormalities were seen in 74%; MRI abnormalities in 64%. Stroke (OR 2.8; 95% CI 1.7–4.6), status epilepticus (OR 3.5; 95% CI 1.4–8.1), and treatment delay >2 weeks (OR 2.1; 95% CI 1.2–3.7) independently predicted poor outcome. Mortality was 9.7%.

Conclusion: Geriatric epilepsy in Western UP is predominantly vascular in origin, with substantial contributions from metabolic disturbances and structural brain lesions. Early neuroimaging, aggressive vascular risk control, and prompt management significantly influence long-term functional outcomes.