In people over 65, epilepsy is the fourth most common neurological disorder after migraine, dementia and stroke. It is more likely to develop in later life than in any other age group. Despite this, it often difficult to diagnose and consequently not treated.
Causes of epilepsy
The most common causes of epilepsy in older people are:
- Disease of the blood vessels in the brain such as stroke or brain aneurysms
- Dementia or Alzheimer’s
- Trauma causing head injuries or brain haemorrhage
- Brain tumours
- Seizures can also occur in relation to some medications, illnesses and infections but these are not considered epilepsy
Diagnosing epilepsy in this age group can be more challenging, particularly if the seizures are subtle, such as focal seizures, and not recognised as seizures. Some other diagnostic challenges that may arise include:
- Multiple medical conditions and medications – Seizures or seizure like activity may be due to or confused with other causes such as; cardiac conditions, kidney or liver failure, diabetes, fainting, migraine, mild strokes, blocked arteries leading to the brain, or vertigo (dizziness with sensation of movement) or medication side effects.
- Many elderly people are often seeing more than one doctor, and sometimes there is poor communication between specialists meaning important health information can be overlooked. It is best to have a GP who can be the central point and coordinator to keep all the health information together.
- Confusional states may be due to seizure or post-seizure activity but may also be due to dementia, psychiatric illness, medication, high fever (infections), urinary tract 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
Because focal seizures are commonly seen in seniors, and are less dramatic than tonic-clonic seizures, they often go unrecognised as epilepsy and are attributed to ageing or dementia.
Episodic blackouts, ‘faints’, ‘funny turns’ and falls are all good reasons to see the doctor as they may be epilepsy. Undetected epileptic seizures in older people are a significant safety concern. Good observation, documentation and description of an event are important to diagnosis.
Antiepileptic 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 antiepileptic medication may interact with those other drugs. So it is especially important to tell your doctor and pharmacists about all medications you are taking because this will influence the doctor’s choice in antiepileptic medication.
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 and you find them unsettling or intolerable, speak 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 may be helpful and can be easily used. These can be obtained from most chemists. You can also get medications pre-packed into similar monthly (disposable) packs, but will need to speak to the pharmacist about costs. See Living with Multiple Medicines.
Never stop taking anti-epileptic drugs without consulting the doctor. This is dangerous and can trigger more severe seizures that could be life threatening.
Epilepsy can substantially affect lifestyle and quality of life at any age, but older people are often more vulnerable to medication side effects, risk of injury and isolation. Having epilepsy at this age undoubtedly contributes to social isolation, withdrawal, anxiety and depression and living alone may make the unpredictable nature of epilepsy more problematic. It is not surprising that a new diagnosis of epilepsy in older people is potentially life changing and may result in many life changes.
Self-management is just as important in this age group as any other. If the person is able, it is important to learn about epilepsy to enable taking an active role in managing the disease. Self-management includes making healthy lifestyle choices and informed decisions about treatment, and actively monitoring and managing symptoms. It can give the person more control over their disease and life. 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 for someone diagnosed with epilepsy in their senior years:
Medications for epilepsy can mix poorly with other medications taken for other conditions or change how either medication acts. Your doctor should be aware of this, but always check with the doctor and chemist about possible side effects and medication combinations.
After effects of seizures are occasionally prolonged, lasting up to one week, with confusion and extreme tiredness. If this occurs, it is important to have a plan, rest and seek support from family, friends or neighbours during this time.
Poor memory can mean forgetting to take medication. Use a calendar, pillbox, set an alarm or take medications with meals, as reminders.
Seizures are more likely to lead to falls, fractures or injury at this age. 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. However many older people cope relatively well with epilepsy and other chronic illnesses. This acceptance may simply reflect a population who has already begun coping and adapting to other illnesses.
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 reminders and medication reviews 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 difficulties and anxiety. Having good supports and keeping in touch with family, friends and community groups is vital.
For more information:
EAA Smartclip – Associate Professor Cecilie Lander – Epilepsy and Seniors