The incidence of epilepsy is higher in older persons than in children. Despite this, it often goes undiagnosed and untreated. (Geriatrics, Feb 2000).
Statistics show that there has been a marked increase (or recognition) of seizures appearing in people over 65 years of age. It is estimated that by the year 2025, 50% of new onset seizures will be in older persons.
Causes of epilepsy
The most common causes of epilepsy in older people are:
- Cerebrovascular disease, eg. stroke, aneurysms
- Dementia or Alzheimers
- Trauma causing head injuries or brain haemorrhage
- Brain infection, eg. meningitis, encephalitis
- Brain tumors
- Up to one third of people have unknown causes
Multiple medical conditions in older people can complicate the picture and make diagnosis difficult. Seizures or seizure like activity may be due to cardiac conditions, kidney or liver failure, diabetes, fainting, migraine, mild strokes, blocked arteries leading to the brain, or vertigo (dizziness with sensation of movement).
Confusional states may be due to seizure or post-seizure activity but may also be due to dementia, psychiatric illness, medication, high fever (infections) or dehydration.
Clear descriptions of the attack or seizure are not always possible, especially if the person is living alone, or there are no witnesses.
Types of seizures in the aged
Because focal (partial) seizures, the most common type of seizures seen in seniors, are less dramatic than tonic-clonic seizures, they often go unrecognised as epilepsy and are attributed to ageing or dementia.
Focal (partial) seizures are those where the seizure activity involves one region of the brain and consciousness may be impaired or altered, but is not lost.
The most common seizures in older people are focal seizures where awareness is retained (often referred to as an aura) and focal dyscognitive seizures (previously called complex partial seizures), particularly after a stroke. They can cause an alteration in awareness or consciousness, usually causing confusion and changes in behaviour.
Generalised seizures occur in both hemispheres of the brain simultaneously and consciousness is usually lost from the onset.
Tonic clonic seizures cause immediate loss of consciousness and usually are less common in the older population, but, when experienced, the risks are much higher for injuries and fractures.
Epilepsy should be considered wherever there are episodic events or 'funny turns'. Undetected epileptic seizures in older people can cause problems and is a safety concern.
Good observation, documentation and description of an event is an important key to diagnosis.
The mainstay of management is medication in conjunction with a healthy lifestyle. The aim of medication is to stop the seizures with minimum side effects.
Anti-epileptic drugs are very effective in controlling seizures in people over the age of 65. People may experience greater sensitivity to medications as they age, so a low dose is usually all that is needed.
If you are taking medications for other health problems, there is a risk that the anti-epileptic medication may interact with those other drugs. So it is especially important to tell your doctor and pharmacists about all medications you are taking.
Older people may be more sensitive to drug side effects which can include tiredness, unsteadiness, tremor, visual disturbances, changes in mood or behaviour, depression or stomach upsets. It may be possible to completely eliminate these by adjusting or changing medications.
Should these occur, you should report any side effects to your doctor or specialist.
Some people have difficulty taking medications regularly. Forgetfulness, confusion over taking multiple medications, or simple problems such as difficulty opening pill bottles may all be involved. It is important for spouses, families and caretakers to be alert for these problems and provide help when necessary.
A weekly pill box, filled with the assistance of a caregiver, may be helpful to the older person and can be easily monitored.
Never stop taking anti-epileptic drugs without consulting the doctor. This is dangerous and can trigger more severe seizures that could be life threatening.
Information is available to suggest that healthy living and self-management may be beneficial in achieving seizure control and well being for the person, particularly when they understand what their triggers for seizures may be. See our Self Management fact sheet for more information.
Adequate sleep, good diet, stress control limitation of alcohol, plenty of exercise and stimulating activities often help in seizure management.
Some issues that may arise with a diagnosis of epilepsy:
Interactions with other medications taken for other conditions can occur. Check with the doctor and chemist about possible side effects and medication combinations.
After effects of seizures can be prolonged, lasting up to one week, with confusion and extreme tiredness. If this occurs, it is important to rest and seek support from family, friends or neighbours during this time.
Poor memory can mean forgetting to take medication. Use a pillbox, alarm clock or taking medications with meals, as reminders.
Seizures are more likely to lead to falls, fractures or injury. To reduce the likelihood of injury during seizures, see our Safety fact sheet for more information.
Many seniors live alone in the community. We can provide information about fall detectors, emergency response services and respite agencies.
Developing epilepsy later in life can be difficult to understand, accept and adjust to.
Our epilepsy educators can help discuss things over the phone, in the office or at your home.
Safety concerns in the home and community. Keeping safe is vital for everyone and sometimes personal monitors or alarms are recommended.
Forgetfulness, poor concentration, memory lapses and mental confusion can be problems for some older people on medication. Regular medication review with the doctor may help.
The fear of injury, falling in public, the problems of taking a longer time to recover from a seizure may contribute to social isolation problems. Keeping in touch with family, friends and community groups is vital.
As always a partnership of care and understanding between you and your doctor, family members, friends and concerned others is critical in the overall management of your seizures.
Remember Epilepsy Action is at your disposal for Advice and Guidance.