Epilepsy in the Elderly

Ann Johnston; Phil EM Smith

Disclosures

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

In This Article

Epidemiology

Epilepsy is defined as the tendency to have recurrent unprovoked seizures. It is the most common serious chronic neurological disorder in the elderly after stroke and dementia. The overall age-specific incidence of epilepsy is bimodal, with a peak in the newborn and a more pronounced peak in those aged over 60 years.[1–4] In a postal survey, 25% of general practitioners were unaware that epilepsy commonly manifests for the first time in older individuals.[5,6] Therefore, contrary to popular belief and more than many clinicians realize, old age is the time of life when seizures, unprovoked or associated with acute illness, are the most common.

The incidence of a first seizure in those aged 40–59 years is 50–60 per 100,000 people, rising in those aged over 65 years to 136 per 100,000. The overall annual incidence of epilepsy – that is, of more than one unprovoked seizure – is 85.9 per 100,000 people in those aged 65–69 years, and 135 per 100,000 people in those aged over 80 years.[7] The prevalence of active epilepsy in the elderly population is up to 1.5%, but among nursing home residents may exceed 5%.[8,9] The incidence and prevalence of epilepsy will only increase further as people live longer.

These accepted epidemiological figures assume a correct diagnosis of epilepsy. In reality, this is unlikely, particularly as the potential diagnostic pitfalls and number of epilepsy mimics increase as age advances. Obtaining an accurate seizure diagnosis in the elderly is challenging and relies much more upon an accurate clinical history and eye-witnessed accounts (which are often absent) than on diagnostic tests. Therefore, the true incidence and prevalence of epilepsy in the elderly, although undoubtedly greater than in younger people, is probably actually lower than commonly reported.

Epilepsy in the elderly is potentially life threatening. Elderly people with epilepsy have a two- to three-times greater mortality than the general population;[10] status epilepticus in the elderly, in particular, may carry a probability of mortality of approximately 50%.[11] Furthermore, seizures in older people more frequently result in physical injury. However, bony fractures in older people with epilepsy more often result from their increased propensity for mechanical falls, rather than from the seizures themselves.[12]

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