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This includes both individuals who have grown old with epilepsy and those who develop epilepsy later in life. Whether seizure outcomes and treatment patterns differ between these groups remains insufficiently characterised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we included patients aged\u2009\u2265\u200965\u00a0years treated at three outpatient epilepsy clinics in Berlin between 2010 and 2025. Patients were categorised according to age at epilepsy onset. Early-onset persistent epilepsy (EOPE) was defined as onset\u2009&lt;\u200940\u00a0years, and late-onset epilepsy (LOE) as onset\u2009\u2265\u200965\u00a0years. The primary endpoint was seizure freedom during the last 12\u00a0months. Secondary endpoints included markers of antiseizure medication burden, adverse effects and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 243 patients were included (114 EOPE, 129 LOE). Seizure freedom was less frequent in EOPE compared to LOE (50.0% vs. 69.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). Patients with EOPE had a significantly higher drug load (median defined daily dose 1.00 vs. 0.67;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). EOPE was independently associated with, among other variables, lower odds of seizure freedom (adjusted odds ratio (adjOR) 0.34, 95%CI 0.16\u20130.71) and more frequent use of first- or second-generation ASM (adjOR 5.99, 95%CI 2.47\u201314.54). The latter finding remained robust in a sensitivity analysis restricted to seizure-free patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In older adults, EOPE and LOE are associated with differing clinical characteristics. Patients with EOPE show lower seizure freedom and higher treatment burden as compared to LOE. In seizure-free patients with long-standing epilepsy, ASM simplification may be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13916-9","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T17:02:13Z","timestamp":1781024533000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Epilepsy in older adults: a comparison of early-onset persistent and late-onset epilepsy"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5017-5824","authenticated-orcid":false,"given":"Nicoletta","family":"D\u00f6rr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5022-1671","authenticated-orcid":false,"given":"Thea","family":"H\u00fcsing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Kleespies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2258-1670","authenticated-orcid":false,"given":"Martin","family":"Holtkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8682-0215","authenticated-orcid":false,"given":"Jakob I.","family":"Doerrfuss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"issue":"3","key":"13916_CR1","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1111\/epi.17494","volume":"64","author":"E Beghi","year":"2023","unstructured":"Beghi E, Giussani G, Costa C, DiFrancesco JC, Dhakar M, Leppik I, Kwan P, Akamatsu N, Cretin B, O\u2019Dwyer R, Kraemer G, Piccenna L, Faught E (2023) The epidemiology of epilepsy in older adults: a narrative review by the ILAE task force on epilepsy in the elderly. 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Epilepsia 63(2):440\u2013450. https:\/\/doi.org\/10.1111\/epi.17153","journal-title":"Epilepsia"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13916-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13916-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13916-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:22:01Z","timestamp":1783495321000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13916-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":41,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["13916"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13916-9","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,9]]},"assertion":[{"value":"31 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"ND declares no conflict of interest related to the manuscript. TH received travel costs from Jazz Pharmaceuticals. HK declares no conflict of interest related to the manuscript. JID reports personal fees from Eisai within the last 3\u00a0years, outside the submitted work. MH reports personal fees from Angelini, Bial, Danone, Desitin, Eisai, Jazz Pharma, Neuraxpharm, and UCB within the last 3\u00a0years, outside the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the local ethics committee of Charit\u00e9 Universit\u00e4tsmedizin Berlin (EA2\/181\/20) and conducted in accordance with the Declaration of Helsinki and relevant institutional guidelines. Due to the retrospective nature of the study, the requirement for written informed consent was waived. We confirm that we have read the Journal\u2019s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"383"}}