{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T10:39:29Z","timestamp":1764671969208,"version":"3.46.0"},"reference-count":44,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The incidence of epilepsy rises markedly after age 50. While late\u2010onset epilepsy (LOE) is often linked to structural brain abnormalities, non\u2010structural factors, such as infections, autoimmune disorders, and neurodegenerative diseases, also contribute. Approximately 20% of LOE cases remain of unknown etiology (LOEU). This study evaluated the diagnostic and therapeutic strategies employed by Italian epileptologists in managing LOE and LOEU, with the ultimate goal of proposing a standardized diagnostic algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected through a cross\u2010sectional online survey administered to neurologists who are formal members of the Italian Chapter of the International League Against Epilepsy (LICE). Descriptive statistics were used to summarize responses, and inferential statistics were applied to derive meaningful conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty\u2010five epilepsy centers across 19 of the 20 Italian regions participated in the survey. EEG (100%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200965) and brain MRI (92.31%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) were routinely employed in the diagnostic evaluation of LOE. In over half of the centers (58.46%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200938), sleep\u2010activated or sleep\u2010influenced EEGs were also used. For LOEU cases, neuropsychological assessments were performed in 60% of centers. More than 30% of centers employed additional diagnostic tools, including lumbar puncture, FDG\u2010PET, and serum antibody testing for neural autoantibodies. The most commonly prescribed anti\u2010seizure medications (ASMs) for LOE were levetiracetam (86.15%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200956), lacosamide (81.54%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953), and lamotrigine (61.54%;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>These findings suggested that Italian epileptologists frequently evaluate patients with LOE during routine outpatient visits. LOEU is increasingly recognized as a distinct subtype of LOE that may warrant a targeted diagnostic approach due to the potential involvement of autoimmune and neurodegenerative mechanisms. There is a pressing need for focused cross\u2010sectional or prospective multicenter studies to refine the diagnostic strategies for LOE, particularly for LOEU, and to enhance the characterization of its clinical and etiological features.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>After age 50, epilepsy rates rise, often linked to brain changes but sometimes with no clear cause (LOEU). We surveyed Italian epilepsy specialists and found that routine EEG and MRI are widely used, yet about 20% of cases require advanced tests to identify rare or autoimmune causes. Our findings will inform patient\u2010focused diagnostic and treatment guidelines and underscore the need for standardized care pathways and further research in adult\u2010onset epilepsy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70131","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T10:26:18Z","timestamp":1757586378000},"page":"1639-1647","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Etiological diagnosis of late\u2010onset epilepsy: A key priority for Italian epileptologists \u2013 Insights from a LICE survey"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7161-3334","authenticated-orcid":false,"given":"Elena","family":"Nardi Cesarini","sequence":"first","affiliation":[{"name":"UOC Neurologia AST Pesaro\u2010Urbino  Fano Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-5246","authenticated-orcid":false,"given":"Giovanni","family":"Falcicchio","sequence":"additional","affiliation":[{"name":"Department of Translational Biomedicine and Neurosciences University of Bari \u2018Aldo Moro\u2019  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2741-4452","authenticated-orcid":false,"given":"Laura","family":"Librizzi","sequence":"additional","affiliation":[{"name":"Epilepsy Unit Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam","family":"Sciaccaluga","sequence":"additional","affiliation":[{"name":"Section of Neurology, Laboratory of Experimental Neurology, Department of Medicine and Surgery University of Perugia  Perugia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Assenza","sequence":"additional","affiliation":[{"name":"Research Unit of Neurology, Department of Medicine and Surgery Universit\u00e0 Campus Bio\u2010Medico di Roma  Roma Italy"},{"name":"Operative Research Unit of Neurology Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo Andrea","family":"Galimberti","sequence":"additional","affiliation":[{"name":"Epilepsy Centre IRCCS Mondino Foundation  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2940-8128","authenticated-orcid":false,"given":"Filippo Sean","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Surgical and Medical Technologies University of Pisa  Pisa Italy"},{"name":"IRCCS Stella Maris Foundation  Calambrone, Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4102-1188","authenticated-orcid":false,"given":"Jacopo C.","family":"DiFrancesco","sequence":"additional","affiliation":[{"name":"Department of Neurology Fondazione IRCCS San Gerardo dei Tintori  Monza Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4862-4221","authenticated-orcid":false,"given":"Cinzia","family":"Costa","sequence":"additional","affiliation":[{"name":"Section of Neurology, Department of Medicine and Surgery, University of Perugia S.M. Misericordia Hospital  Perugia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the \u201cLate\u2010Onset Epilepsy Study Group\u201d of the Lega Italiana contro l'Epilessia (LICE), the Italian Chapter of the International League Against Epilepsy (ILAE)","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02481.x"},{"key":"e_1_2_11_3_1","unstructured":"WHO.Epilepsy: a public health imperative.2019. Available from:https:\/\/www.who.int\/mental_health\/neurology\/epilepsy\/report_2019\/en\/. Accessed 5 Dec 2019."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2005.07.016"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30454-X"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1993.tb02586.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awy022"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)33064-8"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000368801"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70240-6"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.851897"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2024.06.026"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-021-00505-9"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2018.09.006"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2016.08.025"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000493484"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17494"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1996.tb00005.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02946.x"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/WCO.0000000000000539"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.15612"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17489"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12976"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2013.04.342"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2014.10.005"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1230313"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00199"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-210350"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2008.08.005"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-7020-5307-8.00015-6"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurobiolaging.2017.11.005"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13195-023-01181-1"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30044-3"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3233\/JAD-170392"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002923"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004541"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2014.09.004"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics10060356"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00418"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2020-002567"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1684\/epd.2016.0836"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16366"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.01.015"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.17426"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.11041"}],"container-title":["Epilepsia Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi4.70131","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T10:32:01Z","timestamp":1764671521000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi4.70131"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":44,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1002\/epi4.70131"],"URL":"https:\/\/doi.org\/10.1002\/epi4.70131","archive":["Portico"],"relation":{},"ISSN":["2470-9239","2470-9239"],"issn-type":[{"type":"print","value":"2470-9239"},{"type":"electronic","value":"2470-9239"}],"subject":[],"published":{"date-parts":[[2025,9,11]]},"assertion":[{"value":"2025-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}