Epilepsy | Epilepsy and the Aging Brain*
Date: October 19, 2026
Time: 3:45 pm to 5:15 pm
Room: Coral 3
Track: Traditional Special Interest Group (SIG)
Session Description
This session will examine the unique features of epilepsy in older adults, with a focus on new-onset unprovoked seizures (late-onset epilepsy) and the evaluation and management of cognitive impairment in patients with longstanding epilepsy. Faculty will discuss the relationship between epilepsy and Alzheimer’s disease, including the role of biomarker testing, neuropsychological assessment, and potential implications for emerging therapies. Case-based discussions and debates will highlight practical approaches to diagnosis, prognosis, and management in this population.
Learning Objectives
At the conclusion of this session, attendees will be able to:
- Describe current evidence on the prevalence of Alzheimer’s pathology in late-onset epilepsy.
- Assess the prognostic value of Alzheimer’s biomarker testing in this population.
- Identify clinical scenarios in which neuropsychological assessment or Alzheimer’s biomarker testing may be appropriate.
Speakers
- (Chair) James Gugger, MD, PharmD
- (Co-Chair) Heidi Munger Clary, MD, MPH, FACNS, FAES, FANA
- (Speaker) Rani Sarkis, MD, MSc
- (Speaker) Keith Vossel, MD, MSc
- (Speaker) Ifrah Zawar, MD, MS-CR
- (Speaker) Mark Richardson, MD, PhD (2026 SIG Oral Presenter)
Cognitive Decline in Older Adults
Description
As the population of older adults with epilepsy grows, cognitive decline has emerged as a significant clinical concern; older adults with epilepsy face a meaningfully elevated risk of cognitive impairment and dementia compared to the general population, underscoring the need for earlier identification of at-risk patients and deeper understanding of the underlying biological mechanisms.
This presentation examines cognitive decline in older adults with epilepsy, focusing on the relationship between epilepsy, dementia risk, and emerging neurodegenerative biomarkers. We will review current evidence on the epidemiology and mechanisms of cognitive decline in this population. We will then explore the role of blood- and CSF-based biomarkers including plasma p-tau217 in identifying neurodegenerative processes, and discuss how biomarker research may improve risk stratification, disease monitoring, and clinical management. Practical considerations for evaluating cognitive impairment and counseling patients will be addressed, along with the emerging and controversial role of anti-amyloid antibodies in patients with epilepsy, a topic explored through a debate format designed to surface differing clinical perspectives.
Attendees will leave with a clearer understanding of the factors driving cognitive decline in older adults with epilepsy, and practical insight into using neurodegenerative biomarkers to support earlier diagnosis, inform prognosis, and guide patient-centered care.
Debate Session
Description
Epilepsy is increasingly recognized as an important neurological disorder in older adults, with the incidence of new-onset unprovoked seizures rising significantly with age. Diagnosing epilepsy in the elderly can be particularly challenging, as seizures often present atypically and may be mistaken for other neurological or medical conditions. Early recognition and accurate diagnosis are essential to optimizing treatment and improving patient outcomes.
This presentation will explore the unique aspects of epilepsy in the elderly, with a particular focus on the evaluation and management of new-onset unprovoked seizures. Participants will review the epidemiology, common etiologies, and clinical presentations of late-onset epilepsy, discuss diagnostic approaches and differential diagnoses, and examine evidence-based strategies for treatment selection and long-term management. The session will also address age-specific considerations, including comorbidities, medication interactions, and the impact of seizures on cognition, function, and quality of life.
Attendees will leave with a greater understanding of the distinctive features of epilepsy in older adults and practical strategies for recognizing, diagnosing, and managing new-onset unprovoked seizures in this growing patient population.
Overview and update on Late-onset Epilepsy (LOE)
Description
This presentation will provide a practical, evidence-based overview of late-onset epilepsy, with a focus on its unique epidemiology, etiologies, clinical presentations, and outcomes in older adults. It will review common causes of late-onset epilepsy and explore the entity of late-onset unexplained epilepsy, while highlighting the close relationship between late-onset epilepsy and cognitive decline.
Attendees will learn a multimodal diagnostic approach that incorporates epilepsy-protocol MRI, prolonged sleep-inclusive EEG, cognitive assessment, and selected biomarkers. The presentation will also address treatment following a first seizure, age- and frailty-informed antiseizure medication selection, management of status epilepticus, and the role of epilepsy surgery and neuromodulation.
Emphasis will be placed on interdisciplinary care and longitudinal monitoring of common comorbidities. The talk will conclude with a discussion of seizure-related and non-seizure-related outcomes, prognosis, and key considerations for the long-term management of patients with late-onset epilepsy.
Thalamic Network Involvement Reshapes Treatment Selection in Drug-Resistant Epilepsy: Evidence from 104 Patients with Intracranial Thalamic Recordings
Description
Drug-resistant epilepsy remains a major therapeutic challenge, requiring a detailed understanding of the neural networks that contribute to seizure generation and propagation. Increasing evidence suggests that the thalamus plays a critical role in epileptic networks, with important implications for surgical planning and neuromodulation strategies.
This presentation will examine thalamic electrophysiological involvement in drug-resistant epilepsy through the analysis of intracranial thalamic recordings from 104 consecutive patients undergoing stereo-electroencephalography (stereo-EEG). Participants will review how thalamic network activity contributes to seizure dynamics, explore the relationship between thalamic involvement and epilepsy localization, and discuss how these findings can inform treatment selection, including resective surgery and neuromodulation. Topics will also include the potential of intracranial thalamic recordings to refine patient-specific therapeutic strategies and improve clinical outcomes.
Attendees will leave with a greater understanding of the role of thalamic networks in drug-resistant epilepsy and practical insights into how intracranial electrophysiological data can guide personalized treatment selection and advance network-based approaches to epilepsy care.
