Epilepsy is not uncommon in individuals above 65 years of age. Most of the time seizures are consequent to a multitude of diseases affecting the body and brain. Around twenty percent of seizures in adults occur above the age of 65. The elderly population requires special care in the context of epilepsy, as they are prone to falls and injuries and have multiple health problems that can negatively impact the management of epilepsy. After stroke and dementia, epilepsy is the third most common neurological disorder in the elderly.
The elderly are more prone to developing their first seizure in life. The chance of recurrence of seizures is also quite high in this population. The most common cause is stroke. There could be a head injury leading to bleeds in the brain, which could be trivial and missed. Sometimes it is difficult to pinpoint the cause for a seizure. Symptomatic seizures due to disturbances of metabolism, like low blood glucose, or electrolyte disturbances, like low sodium or calcium, are very common. Many medications that the elderly take for their illnesses can be the cause of seizures. Some antibiotics, cough syrups, medications for breathlessness like theophyllines, and medications for mental health disorders can all reduce seizure threshold and cause seizures in the elderly.
A proper clinical evaluation by an expert and timely investigations are critical in a proper diagnosis and management of these seizures. All events that look like seizures need not be seizures. These events could be as benign as a blackout due to blood pressure fluctuation or even a deadly cardiac rhythm disorder that can reduce blood flow to the brain and cause a condition called convulsive syncope. Sleep disorders like parasomnias can mimic seizures in sleep.
In case of suspected epilepsy, a proper history and clinical examination are important in making a diagnosis and planning appropriate investigations and administering treatment. A good clinical examination at the hands of a good clinician can be handy in making a quick diagnosis. Standard investigations for epilepsy include a properly done electroencephalogram (EEG) and MRI of the brain to look for causes of seizure. Ruling out a stroke is important, which requires neuroimaging. All these are done after ruling out symptomatic causes by doing blood tests and investigations like electrocardiograms (ECGs).
Treating epilepsy is a challenge in the elderly. Most of the time they are on multiple medications for multiple health problems like diabetes, high blood pressure, heart disease, high blood cholesterol, endocrine disorders, and malfunction of kidneys or liver. Moreover, they have poor bone health, which can be worsened with treatment. The most important step in the medical management of seizures is classifying the type of epilepsy and choosing the appropriate medication. A good neurologist or epileptologist can do this and choose the appropriate medication, which won't interact with other medicines or negatively impact the health of these individuals. Treatment is very important in the elderly, as not treating epilepsy can lead to falls and even sudden unexpected death, especially in seizures that can occur at night.
Special emphasis has to be given to educating the elderly regarding the need for proper treatment and follow-up. All their comorbid diseases have to be considered. Appropriate treatment and support given at the appropriate time can do wonders in restoring the health and maintaining good quality of life in the elderly.
