Epilepsy and aging

Epilepsy is a common condition of the brain in which a person experiences recurrent unprovoked seizures.

Epilepsy most commonly begins in childhood or in older adulthood, although it can begin at any age. People over 65 years of age have the highest incidence of epilepsy of any age, accounting for almost a quarter of cases of new onset epilepsy.

Due to our aging population, there is an increasing number of older adults with epilepsy, and therefore an increasing need to understand the effects of epilepsy on this group.

The incidence of any type of seizure increases substantially over the age of 60, commonly due to other neurological conditions such as dementia or stroke.

Causes of epilepsy in older people

There are many causes of epilepsy and seizures. The cause of your seizures should be investigated. This will help determine which types of management and support are suitable for you. Common causes of epilepsy in older people include:

• Stroke.
• Brain injury.
• Brain tumour.
• Degenerative conditions such as dementia.
• Medical conditions affecting brain function.
• Other lifestyle risk factors such as alcohol, smoking, sleep deprivation and stress and depression.

Approximately half of all seizures in older adults have no known causes.

If someone is experiencing seizures, it is very important that their cause is properly investigated, as this will help determine the management and support that they need.

Diagnosis of epilepsy in older people

It can be hard to diagnose epilepsy in people in their later years. Epileptic seizures in older people are often mistakenly assumed to be related to another condition (such as dementia), or the ageing process.

Everyone’s experience of a seizure will be different. Some people experience seizures every day, while others only have seizures very rarely or when they forget to take their anti-seizure medication (ASM). People are sometimes not aware that they are having a seizure. For this reason, it is important that friends, family or carers of older people take notice of any behavioural changes.

If you observe behavioural changes in someone you care for, such as seizures or cognitive impairment and confusion:

• make a note of when symptoms occur – for example, do they occur while the person is in specific postures or in association with particular motor movements? How long do periods of confusion last? The ‘Is it epilepsy? Witness statement’ sheet  can help you do this
• recommend that they visit their doctor.

Diagnosis of epilepsy can only be made by a specialist, but accurate, thorough observations can be very helpful in making this diagnosis.

Epilepsy in older people is diagnosed through a combination of:

• observations of friends, family and carers
• medical history
• medical tests, including
  • blood tests
  • EEG (electroencephalogram)
  • CT scan (computed tomography)
  • MRI (magnetic resonance imaging).

Treatment

Deciding on the correct treatment for your epilepsy is important and requires specialist expertise. It is common for people in their later years to have other health conditions which require medications. Your specialist will consider these factors in developing your epilepsy treatment plan.

• Anti-seizure medication (ASM)
• Emergency medication
• Diet
• Surgery

Epilepsy and aged care

People in their later years living in aged care facilities are reported to have a higher occurrence of epilepsy than the wider community.

In older people, seizure activity and any associated behavioural changes can be subtle. It is important that aged care workers and carers know what to look for, can recognise the signs of seizure activity and can document it.

Epilepsy and aged care resources

Epilepsy Smart Australia have produced a suite of Epilepsy in the Later Years resources, which have been developed for older individuals and their families and carers, and for aged care professionals.

Where to get help

• Your GP (doctor)
• The National Epilepsy Support Service (NESS) available Mon – Sat, 9:00am – 7:00pm (AEST) to provide support and information across Australia. Tel:. 1300 761 487 Email: support@epilepsysmart.org.au.