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Most people know they’re at increased risk for certain health conditions as they age: heart disease, stroke, cancer, arthritis, etc.
But there’s a risk you may not be aware of: epilepsy.
Epilepsy tends to make its first appearance during two stages of life: childhood and after age 60. About 447,000 adults older than 65 in the United States have epilepsy, or about 1 percent of that population. That would translate to nearly 800 Washington, D.C., residents who are older than 65. And up to 10 percent of patients in nursing homes are on anti-epileptic drugs.
There are challenges to diagnosing and treating epilepsy in older adults that don’t exist in young people. As our population ages and we live longer, we can expect to see more adults with epilepsy in the future, so it’s important to understand what can trigger epilepsy as we age and recognize the symptoms, both in ourselves and our loved ones.
What causes epilepsy in seniors?
Epilepsy in children tends to have a genetic component. But in seniors, it’s often the result of an underlying condition.
About half of the time, we don’t know why a senior citizen develops epilepsy. For the rest, we usually can trace the cause:
- Stroke (33 percent)
- Neurodegenerative disorders such as Alzheimer’s disease (11 percent)
- Tumors (5 percent)
- Head injury (2 percent)
- Infection (1 percent)
When epilepsy arises from one of these causes, seizures almost always start in one part of the brain, known as focal onset epilepsy. This is in contrast to generalized seizures, which start in multiple areas of the brain. Generalized seizures almost never begin in adulthood.
If you have a stroke or suffer a head injury, seizures may not start immediately. When I tell a patient a stroke may have triggered their epilepsy, they often say, “But that was over a year ago.” It may take a year or more after the event for seizures to appear. This is because it can take that long for the damaged area of the brain to rewire itself.
Epilepsy symptoms in seniors
It sometimes can be difficult to recognize seizures in older adults. Most people think of seizures as causing muscle jerks or spasms. But seizures can have more subtle symptoms, such as staring spells, chewing or nonsense speech, for example. They occur when a smaller, specific area of the brain is affected, such as with focal onset epilepsy.
Unfortunately, these symptoms often are mistaken as dementia or waved off as a sign of someone “just getting older.” Some people also may go to the emergency room because they think they’re experiencing symptoms of another medical condition, such as a stroke.
Symptoms of focal seizures include:
- Hearing or seeing things that aren’t there
- Memory loss
- Repetitive motions such as chewing, lip smacking or mumbling
- Shifts in mood, such as becoming agitated or belligerent
- Staring into space or appearing “out of it”
After one of these seizures, the person may become sleepy but eventually act like themselves again. They may not remember what happened.
If a person lives alone or with someone who doesn’t recognize these red flags, seizures can go on undetected for months or years.
The first step to control seizures is to make a diagnosis. If you or a loved one is experiencing any of these symptoms, including if their behavior has changed or they look like they’re spacing out, talk to a doctor right away.
Some people are embarrassed to admit they’re experiencing hallucinations, confusion or “losing time” during the day. Talk to loved ones regularly about their health. Make them feel comfortable about honestly telling you what’s happening in their daily lives.
Challenges in treating epilepsy in seniors
Focal onset epilepsy often is easier to treat than generalized seizures. If medication doesn’t control the seizures, surgery may be an option.
This doesn’t mean we don’t face challenges in treating seniors with epilepsy. Many older adults take medications for conditions such as high blood pressure, high cholesterol and diabetes. This means we need to find an anti-epileptic medication that doesn’t interact with these drugs.
Anti-epileptic medications need to be taken consistently to keep seizures under control. This means taking it at the same time every day. This can be a challenge for anyone, not just seniors, and it’s compounded if you’re taking multiple medications every day. Your doctor can recommend tips for better medication adherence, such as using a weekly or monthly pill box or setting an alarm on your phone.
It’s likely we’ll see more cases of epilepsy in people older than 60 in the coming years, but with increased awareness and early diagnosis, these patients will have a better chance to control seizures and maintain their quality of life.