Seizure disorders (epilepsy) can affect anyone, at any age, anytime. The nature, causes, types of seizures, and diagnosis and treatment of epilepsy in older people can be different from what they are in younger people. Many older people go undiagnosed and untreated as a result.
A landmark national cost of epilepsy survey conducted by the Epilepsy Foundation found that 550,000 people in the U.S. aged 65 and above have epilepsy. Epilepsy is the third most common neurological disorder affecting the elderly after dementia and stroke.
Between 45,000 and 50,000 new cases occur in people aged 60 and above each year. The incidence in people 65 and above exceeds that of any other age group including children.
Since there is a progressive increase in incidence with age, those 75 years and older (the fastest growing segment of the elderly population) are most at risk of seizures in later life.
Seizure symptoms in older people are most likely to affect just part of the brain and have subtle symptoms. People who are otherwise alert and aware may have behavior episodes easily mistaken for signs of aging. Examples of some of these repeated or recurring episodes are:
- Suspended awareness
- ‘Hearing’ things
- Briefly distorted vision
- Brief loss of speech
- Confused speech
- Lost time
- Momentary ‘blackouts’
- Facial twitching
- Wandering in total unawareness
- Sudden anxiety
The post-seizure state in older people is often prolonged (sometimes days or weeks), can be disabling, and can mimic other age-related conditions.
Epilepsy in older people is frequently the after effect of other health problems. Among risk factors are:
- Cardiovascular disease
- Brain tumor
- Head trauma from falls
- Brain surgery
- Chronic alcoholism
- Pre-existing condition
The incidence rates for epilepsy following stroke range from 10% to 20% percent. People who suffer hemorrhagic stroke (bleeding in the brain) are more likely to develop seizures than those suffering from ischemic stroke (obstruction of blood vessels in the brain). The risk of seizures is six times higher in people with a diagnosis of Alzheimer’s disease and eight times higher in non-Alzheimer’s dementia.
Diagnosis of seizures in older people may be hampered by lack of awareness on the part of the public and health care providers and by the tendency to assume that all of a person’s symptoms are due to a single diagnosis, especially in cases of dementia. Detailed histories health and events in the elderly can be inadequate, inaccurate and difficult to obtain. Changes in brainwaves that might be predictors in younger people may not be significant in older people and can complicate diagnosis.
Treating epilepsy in later life may be challenging because of pre-existing conditions. The lower tolerance of older people to seizure medication increases the risk of drug toxicity and adverse side effects. Side effects include problems with cognitive and motor skills that in turn increase the risk of disabling injuries due to falls. Many physicians are more comfortable and familiar with older seizure drugs, although newer drugs may have more advantages for treatment in older people. Older people may be excluded from consideration for surgery because of their age when surgery may in fact be an effective treatment for them.
- Undiagnosed, misdiagnosed or ineffectively managed seizures in the elderly can hasten the person’s decline and shorten life expectancy. Among major problems are the following:
- Loss of self-confidence
- Fear of socialization, avoidance and isolation.
- Increased dependency
- Depression (elderly already at risk)
- Injury from falls, increased by osteoporosis and brittle bones in older people
- Uncontrolled seizures and their treatment may produce cognitive impairment
- Muscle damage, especially from convulsive seizures and falls
- Relatively minor falls in later life are not only potentially dangerous, they can lead to further decline in functioning and serve as a one-way ticket to the nursing home.