Epilepsy in the Elderly

Ann Johnston; Phil EM Smith

Disclosures

Expert Rev Neurother. 2010;10(12):1899-1910. 

In This Article

Abstract and Introduction

Abstract

Epilepsy is the most common serious neurological disorder in the elderly after stroke and dementia. It may be more important for elderly people because it is intermittent and unpredictable. There is no reliable diagnostic test and so its diagnosis and management requires clinical acumen and experience. The situation is further complicated because the elderly may have many comorbidities and therefore may have many other reasons for losing consciousness. Despite their growing number, there is remarkably little research to underpin the best epilepsy management in the elderly. This article summarizes the scope of epilepsy in elderly people, highlights cerebrovascular and neurodegenerative diseases as the main underlying etiologies, explores the diagnostic challenges in this age group, including the hurdles and processes in their investigation, and examines pertinent clinical management issues.

Introduction

Elderly people with epilepsy are a large, but neglected group. The impact and burden of epilepsy will only increase as the world's population ages. Epilepsy in the elderly may present in many ways; distinguishing epilepsy from potentially more serious epilepsy mimics, including life-threatening conditions, such as cardiac arrhythmic syncope, adds an urgency to the diagnostic process.

'Funny turns', blackouts and falls are common reasons for elderly people to present to general practitioners, emergency departments and specialist epilepsy services. Only a minority may turn out to have epilepsy. It is essential that practicing clinicians are aware of the range of potential differential diagnoses, and can access related services, including specialist physicians in care of the elderly, cardiology or neurology.

Here, we review epilepsy in older people; we consider the scale of the problem, the underlying etiologies and the diagnostic difficulties and challenges. We highlight the greater risks and vulnerabilities of elderly patients to medication, and the special issues of adverse drug effects and pharmacological interactions. We also explore the psychosocial aspects of living with a condition that historically (but within the living memory of many elderly people) carried considerable stigma, and was widely considered akin to 'madness'.

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