About this Research Topic
Epilepsy affects 50 million people worldwide, with increasing prevalence after 55 years of age. A further increase in the incidence and prevalence of epilepsy is expected in aging societies. Making a diagnosis of epilepsy with a high degree of certainty can be challenging in elderly subjects, because the clinical manifestations of seizures, the differential diagnoses and causes of epilepsy can be strikingly different in these patients compared with younger populations.
Older adults with epilepsy consist of two main groups: those who have had epilepsy for many years and those who develop epilepsy de novo in later life, also known as late-onset epilepsy (LOE).
Several causes may underlie LOE, the most common being cerebrovascular disease, head injury, and brain tumors. In about half of older adults with new-onset epilepsy, however, its etiology is unknown (LOEU). Patients with epilepsy have a 1.5 to 4-fold increase in risk of dementia compared to the general population, and it has been suggested that those with LOEU may be a population with a high risk of conversion to Alzheimer’s disease (AD). Unfortunately, and perhaps surprisingly, cognitive decline among epileptic patients has received little attention. It still remains uncertain which patients with LOE are at higher risk of cognitive decline (stratification), what are the main factors participating in such evolution (drivers), and how underlying epileptogenic pathophysiology may contribute to disease progression.
Also, the management of epilepsy in older people may be challenging, compared to that in younger subjects. Age-associated physiological changes can affect the pharmacokinetics and pharmacodynamics of antiseizure medications (ASMs). The use and selection of ASMs is often further complicated by the presence of comorbidities, polytherapy (including ASMs and other drugs), and a higher susceptibility to adverse drug effects. ASMs with fewer adverse effects, including cognitive effects, and ASMs without significant pharmacokinetic drug interactions are needed.
This Research Topic aims to improve our understanding of the relationship between older age and epilepsy. Manuscripts with the following themes are especially welcome:
1. Difficulties in establishing a diagnosis of epilepsy in this population;
2. Discussion of appropriate antiseizure medications
3. The role of psychological and psychosocial comorbidities
4. Cognition in late onset epilepsy
5. Risk of AD and amyloid pathology in patients with late onset epilepsy of unknown etiology
6. The effect of epilepsy on social and care networks both in high-income versus middle-income and low-income countries
7. Proposal (“proof of concept”) or data from clinical trials designed specifically to help older people with epilepsy
8. Relationship between treatment of vascular risk factors and the probability of developing epilepsy;
We welcome clinical or translational research, in the form of original research, commentaries, reviews, systematic reviews, metanalyses and case reports of particular relevance.
Keywords: physiopathology, late-onset, pre-existing, aging
Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.