Seizures in the Elderly

Author: Melanie Zuo, MD

Overview

Nearly 25% of new seizures occur in individuals over the age of 65 years (Leppick & Birnbaum, 2010).

The prevalence rate of epilepsy in community-dwelling elderly is 1.5% (Leppick & Birnbaum, 2010).

Seizures may lead to early loss of independence, emergency department visits, falls, and/or status epilepticus.

The most common causes of seizure in the elderly are:  A distinction must be made between seizures arising from brain pathology (epileptic) and those arising due to an alteration in physiology, such as hypoxia (provoked).

Sleep apnea, which is common in the elderly, probably does not cause seizures but may lower the seizure threshold.

 

Clinical Presentation

The most frequent seizure type in new onset geriatric epilepsy is complex partial seizures.

Complex partial seizures in the elderly can present atypically with parasthesias, dizziness, muscle cramps, confusion, sleepiness, staring spells, and clumsiness. Tonic-clonic movements and automatisms are usually not seen.

Health care providers should consider seizure when there is a history of recurrent episodes of loss of awareness, confusion, and/or shaking that occurs the same way each time and is not attributable to vascular abnormalities or syncope.

Unrecognized seizures in the elderly can cause memory dysfunction, falls, and lead to incorrect diagnosis of delirium or dementia. 

 

Assessment

The presence of cognitive abnormalities, focal abnormality on EEG, and abnormal imaging can increase risk of seizure recurrence.

 

Treatment

Consider treating after the first epileptic seizure occurrence in the elderly. When deciding on treatment take into account the adverse effect profile and altered pharmacokinetics in the elderly. Many anti-epileptics can cause sedation.

Treatment suggestions include:

*The dose may need to be adjusted for renal insufficiency by decreasing the goal dose and decreasing the rate of titration. Observe for excess sedation. 

 

References

Leppik, I.E., & Birnbaum, A.K.(2010). Epilepsy in the elderly. Annals of New York Academy of Sciences: 1184: 208-224 

Pugh, M.J., Cramer, J., Knoefel, J., Charbonneau, A., Mandell, Kazis, A., & Berlowitz, L. (2004). Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy.Journal of American Geriatric Society;52 (3): 417-422.

Ramsay, R.E., Rowan, A.J., & Pryor, F.M. (2004). Special considerations in treating the elderly patient with epilepsy. Neurology:62(5 Suppl 2):S24-S29.

Rowan, A.J., Ramsey, R.E., Collins, J.F., Pryor, F., Boardman, K.D., Uthman, B.M., et al., Tomyanovich, M.L., (2005). New onset geriatric epilepsy: A randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology:64(11):1868-1873.