Changing Presentation of Seizures with Aging: Clinical and Etiological Factors

Abstract

Background: The historically higher incidence of seizures in children has changed, the elderly now have a higher incidence than any age-group, 2–3 times of that found in children. Classical teachings on etiologies, clinical presentation and progression of seizures are based on observations of a younger population and need to be revised in view of features unique to this age-group. The findings of two large VA cooperative studies show that even in sophisticated medical environments, up to 30% of patients 60 years and older with recurrent partial seizures go undiagnosed for more than 1 year of seizure onset. Objective: (a) To characterize the manifestations of auras, seizures and postictal states in the elderly and the relevance of various etiologies to these presentations. (b) To identify and discuss factors that contribute to the difficulties in the diagnosis of seizures in this population. Methods: A review of our experience in treating a large population of elderly patients in a university epilepsy center and a review of the literature relating to the problem. Conclusions: Seizures in the elderly are both overdiagnosed and underdiagnosed: either situation can have serious adverse consequences. Diversity of etiologies and atypical presentations make recognition of seizures difficult. Histories are frequently inadequate: complaints of multiple physical symptoms confuse the picture, unwillingness of elderly patients to admit to problems they believe are physiological in nature by the fear others may think they are ‘losing their mind’ and high staff turnover result in erratic identification of problems. The significant morbidity and mortality associated with poorly controlled seizures in this population are in large part preventable since excellent response to treatment can be achieved in more than 80% of individuals. The correct diagnosis of seizures is more likely if both physician and patients are familiar with the nuances of epilepsy in the elderly.

A Case of Lung Cancer with Brain Metastases Diagnosed After Epileptic Seizure

“…Beyin metastazları ise çoğunlukla hastalık sürecinin geç safhalarında ortaya çıkmasına rağmen primer hastalık tanımlanmadan önce de belirebilir [2]. Toplum kaynaklı yapılan çalışmalarda nöbet bozukluklarının insidans ve prevelansının 60 yaşından sonra arttığı gösterilmiştir [6,7]. Nöbetin ortaya çıkış zamanı ileri yaşlara rastladıkça epilepsinin sekonder sebepleri ön plana çıkmaktadır.…”

Epilepsy and Aging

“…Seizure risk is highest in severe, disabling strokes, in hemorrhagic strokes, and in those with cortical involvement [ 20,26,44,47 ] . Further, the relationship between stroke and epilepsy is bidirectional, in that individuals with late-onset seizures are at higher risk of an initial stroke, owing to a coexistence of vascular risk factors such as hypertension, ischemic heart disease, diabetes, and antiepileptic drug (AED)-related alteration of folate metabolism.…”

“…Seizures are most common in the advanced stages of AD, but early age of onset also is associated with greater risk of seizures, perhaps because of its association with gene mutations [ 20,23,51,53,54 ] . The frequency of seizures is high in patients with AD and Down syndrome, affecting up to 56% of cases [ 55 ] .…”

Factors Triggering Epileptic Seizures in Patients Over 50 Years

“…Epilepsy is the most common neurological disease after cerebrovascular disease and dementia in the elderly. Since it is projected that by the year of 2050, 20% of the world's population will be the aging, it is necessary to focus more seriously on diseases of elderly (6,7).…”