Adult-onset seizures: Clinical solutions to a challenging patient work-up

The age-related increase in the incidence of seizures in older persons is d irectly related to the increase in prevalence of causative factors such as cardiovascular disease and stroke, primary and metastatic brain tumors, tox ic-metabolic disturbances, and medications. Because the treatment plan depe nds on, seizure etiology, comprehensive evaluation of each of these causes is imperative. Reliable history and thorough physical examination remain th e most important steps for diagnosis and effective treatment. Nevertheless, assessment and treatment of new-onset paroxysmal events can be problematic , because numerous morbidities and syndromes-including transient ischemic a ttack, syncope, drug intoxication, amnesia, movement disorders, and psychia tric disorders-can present with similar symptomology.