Why are seizures so hard to recognize in older adults?
That’s because seizures may be hard to recognize in older adults and may go unnoticed. For example, memory problems, confusion, falls, dizziness, or sensory changes like numbness are often blamed on “getting older.” 4,5 However, sometimes these can actually be signs of seizures. 4,5
Why is epilepsy more likely to develop in older adults?
Epilepsy is more likely to develop in older adults because some risk factors for epilepsy are more common in older adults, 3 such as: 1 Strokes. 2 Head injuries due to falls. More ...
What is the postdiagnostic challenge of treating seizures in older adults?
The postdiagnostic challenge for practitioners treating seizures in older adults is prescribing an antiepileptic drug (AED) that can control seizures and be well tolerated by a patient. Illustrating this delicate balance, French describes one of her patients who was experiencing tremors and confusion and was unable to care for herself.
How should the care of the elderly patient with seizures be taken?
The care of the elderly patient with seizures should not solely focus on seizure control. Patients may already be struggling with another neurologic or other disease and will now have to cope with a new diagnosis, loss of driving privileges, and the addition of more medications to an already complicated regimen.
How do seizure disorders differ in the elderly compared to younger patients?
Older patients most often have focal seizures, with less prominent auras and automatisms, and longer duration of postictal confusion compared to younger patients. Status epilepticus is common and has a high mortality.
How do seizures change with age?
The incidence of any type of seizure increases substantially over the age of 60, commonly due to other neurological conditions such as dementia or stroke.
Do seizures decrease with age?
There was an inverse correlation between age and risk of seizures with a peak in patients aged less than 55 years. The risks were higher after recurrent stroke.
Does epilepsy improve with age?
Epilepsy can develop at any age. Early childhood and older adulthood tend to be the most common life stages. The outlook tends to be better for people who develop epilepsy as children — there's a chance they might outgrow it as they age. Developing epilepsy before the age of 12 increases this positive outcome.
Why is age a risk factor for epilepsy?
Age is a variable which is an important determinant for risk factors for epilepsy. Age, as a surrogate of brain maturation, is a determinant of the specific characteristics of the seizure disorder in those with epilepsy, and age-related changes in these manifestations can be identified.
Why do seizures change over time?
-Many hormones have various effects on the brain. Therefore, changes in the hormonal balance of the body can cause changes of seizures. Specifically, one of the female hormones, “estrogen” can worsen seizures, while another hormone, “Progesterone” improves the seizures.
What causes seizures in older adults for the first time?
While new-onset seizures are uncommon in geriatric patients, according to one study the three most common identifiable causes of acute symptomatic seizures in adults were alcohol withdrawal, strokes, and electrolyte disturbances.
Which is the most common seizure experienced by the elderly?
The most common seizure experienced by older adults (66.2%) is the complex partial seizure, which is sometimes called a temporal lobe seizure and is accompanied by impaired consciousness.
At what age does epilepsy usually start?
Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong, but can sometimes get slowly better over time.
What age group has the highest incidence of epilepsy?
The incidence of epilepsy is higher in the youngest and oldest age-groups [11], with estimates of 86 per 100,000 per year in a well-defined population in the first year of age, a trend to decrease to about 23–31 per 100,000 in people aged 30–59 years, and a subsequent increase up to 180 per 100,000 in the over 85 age- ...
How common is epilepsy in the elderly?
The prevalence of epilepsy in the elderly is estimated as 10.8 in 1,000 with yearly incidence of 2.4 in1,000. 3 Strikingly, approximately 24% of new-onset epilepsy occurs after age 60. 4
Who should have a high index of suspicion for seizures in patients with cognitive impairments or behavioral changes?
Primary care providers, gerontologists, and neurologists should all have a high index of suspicion for seizures in patients with cognitive impairments or behavioral changes. In patients who are having seizures, the possibility of secondary causes or late-onset epilepsy must be carefully assessed.
What is the most common seizure semiology?
Focal-onset impaired-awareness se izures remain the most common semiology, likely driven by the development of new focal lesions, 2 with new-onset generalized epilepsies rarely seen. Extratemporal lobe epilepsies are more common than in the younger population. 8 The presenting seizure semiologies may be identical to those in the younger population: staring spells, orobuccal, or hand automatisms. However, some studies have suggested an increased frequency of atypical events such as memory lapses, confusional episodes, and altered mental status. 8 In addition, postictal states may be prominent and prolonged in the elderly, particularly those with underlying cerebral dysfunction. 9
Why is brain imaging important for epilepsy?
Brain imaging is necessary in new-onset epilepsy in the elderly to investigate for both explanatory etiologies, such as stroke or tumor, and potentially reversible causes , such as subdural hematoma. MRI is preferred over CT for its ability to visualize subtle changes or abnormalities within the brain tissue.
Is epilepsy surgery safe for seizures?
Despite concerns about decline in verbal memory, epilepsy surgery remains a curative option for patients with drug-resistant seizures. Less invasive and selective procedures are now available and carry a lower risk of cognitive decline.
Is epilepsy a paraneoplastic disease?
Paraneoplastic and autoimmune causes of epilepsy are being increasingly recognized in previously idiopathic cases, although the prevalence of these in the elderly remains unknown and possibly underrecognized.
Should elderly patients with seizures be treated?
The care of the elderly patient with seizures should not solely focus on seizure control. Patients may already be struggling with another neurologic or other disease and will now have to cope with a new diagnosis, loss of driving privileges, and the addition of more medications to an already complicated regimen.
How was the percentage of children and adolescents with seizures determined?
First, the percentage of children and adolescents with seizures was ascertained through parent reports, which were not corroborated by other sources, and might be subject to misclassification or response biases. Second, this study might inadvertently include children and adolescents with febrile seizures.
How old are children when they have febrile seizures?
Second, this study might inadvertently include children and adolescents with febrile seizures. However, because febrile seizures usually occur in children aged 6 months–5 years ( 7 ), limiting analyses to children and adolescents aged 6–17 years should have excluded almost all children with febrile seizures.
What is a seizure in children?
A seizure is a brief change in normal electrical brain activity resulting in alterations in awareness, perception, behavior, or movement. Seizures affect persons of all ages, but are particularly common in childhood. There are many causes of seizures in children, including epilepsy; high fever (febrile seizures); head injuries; infections (e.g., malaria, meningitis, and gastrointestinal illness); metabolic, neurodevelopmental, and cardiovascular conditions; and complications associated with birth ( 1 – 3 ). Outcomes associated with single or recurring seizures in children vary by seizure type (febrile compared with nonfebrile) and multiple risk factors (age, illness, family history, and family context). Outcomes range from no complications to increased risk for behavioral problems, epilepsy, or sudden unexpected death ( 3 – 6 ). No nationally representative estimates have been reported for the number of U.S. children and adolescents with seizures, co-occurring conditions, or health service utilization. To address these information gaps, CDC analyzed combined data on children and adolescents aged 6–17 years from the National Health Interview Survey (NHIS) for the period 2010–2014. Overall, 0.7% of children and adolescents (weighted national estimate = 336,000) were reported to have had at least one seizure during the preceding year. Compared with children and adolescents without seizures, a higher percentage of those with seizures were socially and economically disadvantaged. Children and adolescents with seizures had higher prevalences of various mental, developmental, physical, and functional co-occurring conditions than those without seizures; however, only 65.6% of those with seizures had visited a medical specialist (defined as a medical doctor who specializes in a particular medical disease or problem, other than an obstetrician/gynecologist, psychiatrist, or ophthalmologist) during the preceding 12 months. Public health agencies can work with other health and human service agencies to raise awareness about childhood seizures, implement strategies to prevent known causes and risk factors for seizures, study the associations between sociodemographic characteristics and seizure incidence, and ensure linkages for children with seizures to appropriate clinical and community providers.
What are the consequences of a single recurring seizure in children?
Outcomes range from no complications to increased risk for behavioral problems, epilepsy, or sudden unexpected death ( 3 – 6 ).
Do children with seizures need a doctor?
Although most children and adolescents with seizures had recently seen a general doctor, they frequently require the care of a specialist, such as a neurologist, and parents of approximately one third of those with seizures reported that they had not recently seen or talked to a medical specialist.
Does NHIS ask about seizures?
Finally, because NHIS does not ask about seizure type and frequency in children and adolescents, it is not possible to confirm whether children and adolescents with reported seizures had epilepsy, or to determine the etiology of the seizure or seizures.
Can seizures be prevented?
Seizures in children and adolescents vary by cause, severity, and impact. The risk for some seizures can be prevented or reduced by eliminating their causes, such as ensuring proper prenatal and per inatal care and preventing head injuries.
What is a seizure in older adults?
Seizures in Older Adults. Often described as body stiffening, falling, and jerking movements accompanied by a loss of consciousness, seizures typically present in this manner and are generally classified as tonic-clonic seizures (grand mal seizures). Yet these electrical disturbances in the brain vary significantly, ...
Why do older people have seizures?
Seizures among older adults can be attributed to myriad conditions that affect the brain; the Epilepsy Foundation states that seizures are associated with physical changes in an elder’s brain caused by a stroke, heart disease, Alzheimer’s disease, or brain tumors.
How long does a seizure last in older adults?
“Ninety percent of seizures last anywhere between seconds up to three minutes; the seizure itself usually doesn’t last longer than three minutes,” French says.
How many people have epilepsy?
According to the Epilepsy Foundation, more than 570,000 people aged 65 and older have epilepsy, and older adults are the fastest growing population to be affected by the disease.
Is epilepsy cryptogenic?
However, French says that in at least one half of the elder patients who develop epilepsy the etiology is cryptogenic, meaning the origin or cause hasn’t been identified. Although various factors can increase the risk of developing seizures, they sometimes occur in the absence of any known risks.
Why do elderly people have seizures?
The cause of seizures in elderly patients is usually epilepsy, but it’s worth emphasizing that seizures in seniors can be the result of many things. For example, a non-epileptic seizure can be caused by a physical condition or even stress.
What is a seizure in elderly people?
Seizures in Elderly People & Types of Seizures. Seizures are essentially an electrical disturbance in the brain; the type of seizure a person experiences will depend on the location of the disturbance. For instance, a generalized seizure involves the entire brain being swarmed with electrical activity. That can lead to convulsions, falls, strange ...
How long does it take for a seizure to go away?
Symptoms of a seizure usually go away within three minutes, though a return to full consciousness can take up to an hour. After a seizure is over, it’s not uncommon for seniors to experience a loss of bladder control, or to sweat profusely. Treatment options will depend on the cause.
Can seniors take baths with epilepsy?
However, seniors with epilepsy shouldn’t take baths without someone to check their safety, a short lapse in consciousness can be lethal. While epilepsy is a completely manageable condition, it can make swimming alone, climbing ladders, and operating heavy machinery very dangerous.
Can you test for epilepsy after a seizure?
It’s often a good idea to test for epilepsy after a seizure, which can involve an EEG, MRI, or CT scan. With an affirmative diagnosis, there are a variety of medications that can be used to manage symptoms. Similarly, treatment for non-epileptic seizures usually involves cognitive behavioral therapy to help heal injuries and reduce stress.
Can seizures be mistaken for dementia?
The symptoms of seizures can easily be mistaken for other a variety of conditions, from dementia to stroke . Confusion like that can make responding appropriately to a seizure more challenging. This is why it can be so important to learn what to do if an elderly person has a seizure, what to do after a seizure, and what the symptoms ...
When do seizures occur in Alzheimer's?
Seizures usually occur in later stages of Alzheimer's disease, on average, > or =6 years into the course of the disease. Seizures in Alzheimer's disease are more likely to occur with early-onset disease, particularly if there is a familial presenilin I mutation.
How many seizures are there in dementia?
In patients with Alzheimer's disease (the most common form of dementia), approximately 10-22% have at least one unprovoked seizure.
Can cognitive impairment cause seizures?
First, the presence of cognitive impairment may impede an accurate diagnosis of seizures. Clinicians may also mistake seizure manifestations for symptoms of the underlying dementia. Second, since most dementia patients are elderly, there are pharmacokinetic changes with aging that affect the use of antiepileptic drugs.
Do elderly people have seizures?
Seizures in elderly patients with dementia: epidemiology and management. Epileptic seizures occur in patients with dementia at a higher prevalence than among healthy elderly individuals. The incidence of seizures among patients with dementia varies with the aetiology of the dementing illness. In patients with Alzheimer's disease (the most common ...
Incidence and Etiology
Clinical Presentation and Differential Diagnosis
Diagnostic Studies
Treatment and Follow-Up Care
Team-Based Care
Conclusion
- Although usually successful, the treatment of seizures in the elderly requires a coordinated effort. All care providers for these patients must work together to ensure medication tolerability, avoidance of drug interactions, seizure triggers including drugs that lower the seizure threshold, comorbidities that may be masked or worsened by seizures a...
Rani A. Sarkis, MD, Msc
Matthew Schrettner, MD