LATE-ONSET EPILEPSY IN THE ELDERLY: DIFFICULTIES OF DIAGNOSIS AND PERSONALIZED PHARMACOLOGICAL MANAGEMENT, WITH PARTICULARITIES TO COVID-19 PANDEMIC – SYSTEMATIC REVIEW OF LITERATURE
AURELIAN ANGHELESCU 1,2#, GELU ONOSE 1,2#, VLAD CIOBANU 3, RUXANDRA
MIHALACHE 2,4*, AURA SPANU 1,2, CRISTINA POPESCU 1,2, MIHAELA OPREA 1,2, CARMEN FLORENTINA FIRAN 2,5, ALEXANDRU CAPISIZU 2,6
1Neurorehabilitation Department, Teaching Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3Computer Science Department, Polytechnic University of Bucharest, Bucharest, Romania
4Geriatrics Department, “Sf. Luca” Hospital, Bucharest, Romania 5Ilfov County Emergency Clinical Hospital, Bucharest, Romania
6Psychiatric Hospital “Dr. C. Gorgos” Bucharest, Romania
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In the actual demographic and pandemic context, epilepsy in people over 65 years is a multidimensional issue and a challenge to public health care. Systematic reviews and meta-analyses on the subject are scarce. A systematic and synthetic analysis of the literature published in the last 10 years (2011 - 2020) was performed, using the “Preferred reporting items for systematic reviews and meta-analyses” (PRISMA) paradigm. All identified papers were subjected to a standardized related filtering endeavour, in five steps, using PRISMA inspired selection methodology. Ultimately, there were selected 56 eligible articles; nonetheless, we enlarged our bibliographic base with additional resources related to the subject, freely discovered in the literature. The paper emphasizes elements of descriptive epidemiology, clinical presentations, differential diagnosis, and special issues in the treatment and prognosis of late-onset epilepsy in the elderly. The therapeutic decision in late-onset epilepsy is considered in the holistic frame of the neurologic pathology, pharmacological and pharmacokinetic issues specific for the old persons. The elderly is susceptible to drug-induced acute seizures because of the high prevalence of co-morbidities or polypharmacy. Special considerations were focused on COVID-19 associated seizures. Management of elderly patients with late-onset seizures/epilepsy requires special considerations concerning the positive and differential diagnosis, aetiology, prognosis and treatment.
