{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:21:57Z","timestamp":1785910917774,"version":"3.56.0"},"reference-count":34,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["UE5 NS065723\u201016"],"award-info":[{"award-number":["UE5 NS065723\u201016"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01 NS033310"],"award-info":[{"award-number":["R01 NS033310"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01 AG058820"],"award-info":[{"award-number":["R01 AG058820"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01 AG075955"],"award-info":[{"award-number":["R01 AG075955"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R56 AG074473"],"award-info":[{"award-number":["R56 AG074473"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["UH2 AG083254"],"award-info":[{"award-number":["UH2 AG083254"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia Open"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Late\u2010onset epilepsy of unknown etiology (LOEU) carries an elevated risk of dementia, suggesting that it may represent an early manifestation of neurodegenerative or cerebrovascular disease. Direct comparisons between LOEU and acquired lesional late\u2010onset epilepsy (LOE) may elucidate clinical features specific to LOEU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective chart review of patients with LOE, with first documented seizure at age 55 or older, whose evaluation included an epilepsy\u2010protocol brain MRI and\/or inpatient video\u2010EEG evaluation. Etiology was determined from neuroimaging lesions and medical history. Patients without an identified etiology were categorized as LOEU. Analyses were performed controlling for sex, age of onset, and epilepsy duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 75 LOEU (mean onset: 64.9\u2009years, 38.7% female) and 57 acquired lesional LOE cases with etiologies including cortical stroke, hemorrhage, neoplasm, trauma, or infection (mean onset: 66.5\u2009years, 36.8% female). LOEU was less likely to have a history of status epilepticus (6.7% vs. 21.1%, aOR: 0.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.03) or to have undergone inpatient video\u2010EEG monitoring (13.3% vs. 24.6%, aOR: 0.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.04). LOEU was prescribed fewer ASMs compared to acquired lesional LOE (aOR: 0.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.02), and LOEU patients prescribed multiple ASMs had lower average 12\u2010month seizure frequency than acquired lesional LOE (median: 0.2 vs. 1.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). LOEU had lower rates of vascular comorbidities than acquired lesional LOE, though rates of subsequent dementia were not significantly different (5\u2010year risk: 16.6% vs. 17.7%). An exploratory cluster analysis demonstrated an LOEU subgroup with older onset, higher prevalence of white matter hyperintensities, cerebral atrophy, epileptiform discharges, and greater epilepsy severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>LOEU was associated with fewer proxies for epilepsy severity, signifying that LOEU is more often treatment\u2010responsive than acquired lesional LOE. LOEU has lower rates of comorbid vascular disease compared to acquired lesional LOE, suggesting that occult cerebrovascular disease is not overrepresented in LOEU relative to other forms of LOE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain Language Summary<\/jats:title>\n                    <jats:p>People who develop epilepsy after age 55 without a known cause usually respond well to treatment and need fewer antiseizure medications than people with epilepsy from a known brain injury. In this study, they had fewer hospital stays for seizure monitoring and fewer vascular problems. Dementia risk was high in patients with late\u2010onset epilepsy, both when the cause was known and when it was unknown. Late\u2010onset epilepsy without a known cause is often less severe but still needs regular monitoring for memory and thinking problems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi4.70156","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T23:42:09Z","timestamp":1759794129000},"page":"1847-1859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Late\u2010onset epilepsy of unknown etiology is more treatment\u2010responsive than acquired lesional late\u2010onset epilepsy"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7685-9562","authenticated-orcid":false,"given":"L. Brian","family":"Hickman","sequence":"first","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavya","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fish","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohit","family":"Bandla","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Husein","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinne","family":"Allas","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harika","family":"Kottakota","sequence":"additional","affiliation":[{"name":"Department of Neurology, David Geffen School of Medicine University of California, Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Herzog","sequence":"additional","affiliation":[{"name":"Department of Neurology, Perelman School of Medicine University of 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