The fastest growing segment of the American population is the elderly. Moreover, they are also the fastest growing segment of the population with new-onset epilepsy and recurrent seizures. Many medical conditions that are common among the elderly population—including stroke, intracranial hemorrhage, brain tumor, and dementia—have a higher risk for resultant epilepsy, hence the higher incidence of epilepsy in this age group. This special subgroup of epilepsy patients presents unique challenges, including diagnosis, management, risk factors, and medication choice. Many of these challenges are interrelated.
The first and possibly the most difficult challenge is diagnosis. Seizures can begin at any age, not necessarily childhood. There does not have to be a genetic family history of epilepsy. Seizures in the elderly can present in a subtle fashion and are often not recognized as such. In addition, these symptoms are often attributed to other common medical conditions or lumped together with other generic symptoms that are frequently seen in the elderly.
For example, seizures can present with one or more of the following: slow speech, pauses in speech, confusion, memory loss, loss of track of time, trembling of the extremities, blinking, staring, slow responsiveness, chewing movements, and grabbing movements. As such, seizures may be misidentified as dementia, tremor, a movement disorder, delirium, overall slowness, or “aging.”
The potential implication has a compounding effect. Individuals with these symptoms can be diagnosed with a condition that they do not have, prescribed medication that they do not need, and be subject to the side effects of this incorrect medication. In addition, the patient could have unnecessary diagnostic testing, which can be a hardship in this population.
The correct diagnosis, in this case seizures/epilepsy, may be delayed, which could lead to potential consequences such as recurrent seizures, falls, injury, memory loss, and possible sudden death. This contributes to a decreased quality of life.
What are the central issues that lead to the delayed diagnosis? First, as mentioned above, the presentation can be quite subtle. Unlike what is most often portrayed in the media, not all seizures involve a loss of consciousness, body stiffening, and/or body shaking. Second, the patient is not necessarily aware that the above symptoms have occurred. It is often a friend or family member that reports them, and the patient may deny the occurrence. Third, even after the diagnosis is confirmed the patient may still be skeptical because he/she is still “functioning.” Often the question becomes how long have these signs/symptoms actually been present?
Epilepsy in the elderly is real and increasing. Unfortunately, it is frequently this subgroup of the population that has the least education about the disease. Increasing awareness of epilepsy is an ongoing goal by epilepsy advocacy organizations. Along with these organizations, physicians and other health care provides need to play an active role in increasing awareness for this special subpopulation with epilepsy.