{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T06:04:12Z","timestamp":1774418652401,"version":"3.50.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T00:00:00Z","timestamp":1645574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>The aim of this study was to describe the electroclinical and prognostic characteristics, and to investigate the role of leukoaraiosis in outpatients with new-onset elderly focal epilepsy aged \u226560 years, referred to a tertiary epilepsy center between 2005 and December 31, 2020. Among the 720 patients who were referred to the center, we retrospectively selected 162 consecutive outpatients, with a first referral for recent-onset focal epilepsy of unknown cause (UC) or structural cause (SC), and collected a clinical and standard-Electroencephalogram (S-EEG), 24-h ambulatory EEG (A-EEG), and neuroimaging data. We also analyzed the seizure prognosis after titration of the first antiseizure medication (ASM). One hundred and four UC and 58 SC patients, followed up for 5.8 \u00b1 5.3 years (mean \u00b1 SD), were included. Compared with the SC group, the patients with UC showed a predominance of focal seizures with impaired awareness (51.9% of cases) and focal to bilateral tonic-clonic seizures during sleep (25%); conversely, the SC group, more frequently, had focal to bilateral tonic-clonic seizures during wakefulness (39.6%) and focal aware seizures (25.8%) (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001). Oral or gestural automatisms were prevalent in UC epilepsy (20.2 vs. 6.9% in the SC group, <jats:italic>p<\/jats:italic> = 0.04). In UC compared to patients with SC, interictal epileptiform discharges showed a preferential temporal lobe localization (<jats:italic>p<\/jats:italic> = 0.0007), low expression on S-EEG, and marked activation during deep Non-Rapid Eye Movement (NREM) sleep (<jats:italic>p<\/jats:italic> = 0.003). An overall good treatment response was found in the whole sample, with a probability of seizure freedom of 68.9% for 1 year. The cumulative probability of seizure freedom was significantly higher in the UC compared with the SC group (<jats:italic>p<\/jats:italic> &amp;lt; 0.0001). The prognosis was worsened by leukoaraiosis (<jats:italic>p<\/jats:italic> = 0.012). In the late-onset focal epilepsy of unknown cause, electroclinical findings suggest a temporal lobe origin of the seizures. This group showed a better prognosis compared with the patients with structural epilepsy. Leukoaraiosis, <jats:italic>per se<\/jats:italic>, negatively impacted on seizure prognosis.<\/jats:p>","DOI":"10.3389\/fneur.2022.828493","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T13:17:27Z","timestamp":1646054247000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Late-Onset Focal Epilepsy: Electroclinical Features and Prognostic Role of Leukoaraiosis"],"prefix":"10.3389","volume":"13","author":[{"given":"Elena","family":"Tartara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Micalizzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofia","family":"Scanziani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Ballante","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Paoletti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo Andrea","family":"Galimberti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1528-1157.1992.tb06222.x","article-title":"Seizure disorders: the changes with age","volume":"33","author":"Hauser","year":"1992","journal-title":"Epilepsia."},{"key":"B2","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1111\/j.1528-1157.1996.tb00007.x","article-title":"Partial epilepsy of long duration: changing semiology with age","volume":"37","author":"Tinuper","year":"1996","journal-title":"Epilepsia."},{"key":"B3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1111\/j.0013-9580.2004.29003.x","article-title":"Seizure semiology in the elderly: a video analysis","volume":"45","author":"Kellinghaus","year":"2004","journal-title":"Epilepsia."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1498","DOI":"10.1016\/j.clinph.2014.10.155","article-title":"Interictal spiking in adult newly-diagnosed focal epilepsy of unknown cause: the effect of age","volume":"126","author":"Arbasino","year":"2015","journal-title":"Clin Neurophysiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"S24","DOI":"10.1212\/WNL.62.5_suppl_2.S24","article-title":"Special considerations in treating the elderly patient with epilepsy","volume":"62","author":"Ramsay","year":"2004","journal-title":"Neurology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.seizure.2016.03.011","article-title":"Clinical features and prognosis of epilepsy in the elderly in western China","volume":"38","author":"Huang","year":"2016","journal-title":"Seizure."},{"key":"B7","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.yebeh.2005.11.007","article-title":"Pharmacological outcomes in older people with newly diagnosed epilepsy","volume":"8","author":"Stephen","year":"2006","journal-title":"Epilepsy Behav."},{"key":"B8","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.yebeh.2012.11.041","article-title":"del C, Gonorazky SE, Romano LM. 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