Epilepsy in the elderly

Did you know?

For elderly people, the successful treatment of epilepsy in no way reduces the ability to control their lives.

As recently as a few decades ago, there was a common belief that epileptic seizures and epilepsy were most common during early childhood and young adulthood. Nowadays, the majority of first seizures occur among older people.

Common forms of seizure in the elderly

The following types of seizures are found most commonly in the elderly:

  • short periods of confusion and disturbance of memory,
  • sudden glaring into emptiness with an expressionless look accompanied by a transient loss of orientation in time and space, and in relation to people,
  • sudden tingling in the limbs (more prominent on one side of the body),
  • sudden dizziness or vertigo,
  • muscle spasms on one side: face, neck, shoulder, upper and lower limbs (or only a part of those areas),
  • generalized seizures with loss of consciousness and spasms throughout the body, often biting the tongue and losing control of bladder and bowels,
  • non-responsiveness with unconsciousness, but without spasms.

Conditions that are often confused with epilepsy in the elderly

Fainting or syncope is the most common cause of short-term loss of consciousness in elderly people. The causes of syncope are in the functioning of the cardiovascular system when the blood pressure and heart rate fall.

A drop in blood sugar levels (hypoglycaemia) may lead to confusion or even loss of consciousness if the level of blood sugar plummets very low.

Confusion may often result from febrile condition due to various causes, or from the use of tranquillizers or insomnia medications.

Sleep disorders, especially insomnia, are quite common among elderly people. They may experience nightmares with severe agitation, which may be mistaken as an epileptic seizure.

Transient ischemic attack (TIA) is common in old age. Sudden speech disturbances may occur during such transient events, during which a person cannot answer questions or does not understand speech.

Transient disorder in the operation of short-term memory (transient global amnesia) is also common in old age. It characteristically lasts several hours or up to one day and then spontaneously disappears, but a memory gap remains for this period.

How is epilepsy treated?

People with epilepsy in old age generally respond well to treatment. It is therefore important that the disease is recognized and treated as early as possible by administering proper anti-epileptic medications in age-appropriate, usually smaller doses.

Ageing changes the physical ability to metabolise medicines. The absorption of matter in the digestive tract is slowed down, the manner of transporting and distributing medication throughout the body is also different, and its elimination slows. All of this is also affected by concomitant diseases, which tend to become more common with advancing age. As a result, the elderly do not tolerate medication as well as they did in younger years. The start of treatment with anti-epileptic medicines is generally slower, the first doses are smaller and increase gradually. This way, it is easier for a patient to get used to it. The required final daily dose is also usually reduced.

Quality of life and epilepsy

For elderly people, the successful treatment of epilepsy in no way reduces the ability to control their lives. There are many possibilities to manage seizures, especially with the new medicines, and the treatment is not accompanied by any major issues.

The occurrence of epileptic seizure or epilepsy in advanced age does not necessarily mean a permanent loss of the ability to drive a car if seizures are under control by means of medication and the medication causes no significant adverse effects.

The majority of recreational activities and sports are allowed and even highly recommended to elderly people with epilepsy.

Travelling does not increase the risk of seizures. It is reasonable to avoid increased stress and lack of sleep during the travel, if possible. Potential adverse circumstances on the quality of life may be outweighed by social and other positive effects of travel.

The content of this article has been created on the basis of the “Epilepsy in the Elderly” brochure (available in Slovenian under title “Epilepsija pri starejših”) by Dominika Novak, Marko Zupan, Gal Granda and Bogdan Lorber. Publisher: Medis, d.o.o.

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