Green SF, Loefflad N, Heaney DC, et al. - Despite concerns over polypharmacy and comorbidity, the findings demonstrate the management of first seizures in older people and provisionally support the use of anti-seizure medications (ASMs) in patients with increasing age and frailty. The observations should be replicated in larger cohorts.

• Researchers designed a retrospective single-center cohort study including a total of 207 cases ≥ 60 years old, 113 of whom were eventually diagnosed with a first seizure in a specialist epilepsy clinic.

• It was shown that 65/113 (57.5%) presented with either focal aware or focal impaired awareness seizures.

• The study found stroke as the most common aetiological association (31.9%, 36/113), and the likelihood of seizure recurrence did not significantly differ between aetiologies. 55/86 (64.0%) who started an ASM had no seizure recurrence.

• Epileptiform abnormalities were seen in 14/48 (29.2%) who had undergone EEG, nevertheless, EEG results directly affected management in only 4/48 (8.3%) Small vessel disease (37/93, 39.8%), stroke (27/93, 29.0%), and global atrophy (14/93, 15.1%) were the most common MRI findings.

• The odds of seizure recurrence or of experiencing ASM side effects were not affected by increasing age and frailty.

• The odds of seizure recurrence were not affected by the severity of small vessel disease or atrophy.