Faculty Bibliography

We prospectively investigated drug-induced headaches (HA) among 60 epileptic patients receiving felbamate (FBM). Twenty patients (33%) experienced HA. HA was pounding in 11 (55%), steady in 9 (45%), moderate or severe in 19 (95%), occurred at least once a week in all patients, and was relieved by nonnarcotic analgesics in 14 (70%). Mean duration on FBM before HA onset was 19 days. HA occurred with higher FBM doses and was relieved in 8 of 13 patients (62%) with FBM dose reduction. FBM was discontinued in most cases because of risks of anemia or hepatitis; not because of HA. Other side effects included insomnia (25%), gastrointestinal symptoms (27%), and agitation or restlessness (23%). HA is a common dose-related complication of FBM, occurs early after initiation of FBM treatment, and is relieved by dose reduction.

We studied 80 hospitalized patients over 60 years old with either new-onset or newly diagnosed seizures that were generalized tonic-clonic in approximately half the cases and partial with or without secondary generalization in the other half. The etiology of seizures was acute symptomatic in 33 (41%), remote symptomatic in 32 (40%), progressive encephalopathy in nine (11%), and idiopathic in six (8%). Convulsive status epilepticus occurred in five cases (6%). The most common single cause of seizures was infarction or hemorrhage (54%). Morbidity and mortality were highest in the acute symptomatic group (p < 0.03). Nine (11%) of the subjects died within 3 months of admission, including two of the five with status epilepticus. Of the patients with acute symptomatic etiologies, 21% died compared with 6% of those in the remote symptomatic group. New neurologic deficits were present in eight (11%) of the 71 who survived, including five acute symptomatic, one remote symptomatic, and two progressive encephalopathy cases. No patient with idiopathic seizures died or had new neurologic deficits. We conclude that seizures in the elderly requiring hospitalization occur mainly with acute and remote symptomatic neurologic insults and are associated with a significant morbidity and mortality. In the absence of any associated neurologic insults, the morbidity is low.