Epilepsy in the Elderly

Ann Johnston; Phil EM Smith


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

In This Article


Blood Tests

Blood tests in elderly patients, such as a full blood count, urea and electrolytes, and plasma glucose, are rarely taken in specialist epilepsy clinics, unless specifically indicated. However, in the acute situation of an elderly person presenting with an episode of altered consciousness, a plasma glucose level is essential (usually already taken by ambulance or accident and emergency personnel) to exclude hypoglycemia from treated diabetes mellitus or from alcoholism.


A 12-lead ECG is essential for all blackouts, 'funny turns' or suspected epilepsy[30] and becomes more important with increasing age, given the increased likelihood of ischemic heart disease. In people who have blacked out and have an abnormal ECG, an ECG (alongside an urgent cardiologist referral) will help to exclude structural heart disease. Further specialist cardiac investigations, such as an implantable loop recorder (e.g., Reveal©), and electrophysiological studies may be appropriate.


A routine interictal electroencephalogram (EEG) is rarely helpful in the elderly since it is much less sensitive or specific to epilepsy than in younger people. With increasing age, up to 40% of individuals develop EEG abnormalities, but elderly people with seizures rarely have typical epileptiform activity on interictal EEGs: clearly, the absence of epileptiform discharges does not rule out epilepsy.[17] Therefore, interpreting an EEG in an elderly patient requires caution. Nonconvulsive status is the one clinical situation in the elderly where the EEG is definitely indicated, showing continuous epileptiform activity in a patient who is confused or who has altered mental status.


Brain imaging is indicated in all elderly patients with new-onset seizures.[30] MRI is the gold standard, detecting potentially epileptogenic pathology more accurately than computed tomography. Nonspecific age-related changes, such as diffuse atrophy and periventricular hyperintensities from hypertension, are common and increase with age. These are rarely the cause of seizures and again must be interpreted with caution.[30]


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