Seizure in later life: an ode to the elderly

Abstract

INTRODUCTIONThe advances in the current medical science and technology have strived forward in increasing longevity of the population. Major economies in the worlddeveloping and developed alike are facing an ever increasing graying population with the inherent risk of morbidity and mortality. The combined endpoint of a mechanized and sedentary lifestyle added up with an increase in life span invites our acuity towards a fragile unbalanced segment of the society to whom we are obliged for what we are.Epilepsy is the third most common neurological disorder in old age after dementia and stroke. The elderly are now the group with the highest incidence of epilepsy in the general population. 1 Incidence rates of over 100 per 100000 for epilepsy in people over 60 years old have been reported in contemporary literature. 2The incidence of acute symptomatic or provoked seizures also rises significantly in older persons 3 and the prevalence of epilepsy increases with advancing age, although to a lesser degree.Different studies show considerable variability in the etiology and risk factors for epilepsy. [4][5][6] The most frequently reported risk factor is cerebrovascular disease. Tumors, metabolic and toxic causes and cerebral hypoxia secondary to the many causes of syncope in old age account for around 10% of all seizures. 5,7 Other causes of seizures include head injury, infection, subdural haematoma and neurodegenerative disorders. ABSTRACTBackground: Seizure disorder and epilepsy are one of the common presenting symptoms to an emergency department for geriatric population. Cerebrovascular accident, metabolic derangement, trauma, neurodegenerative diseases, tumor, infections and psychiatric illnesses add up to the frequent etiological spectrum of seizure in elderly. Objective of current study was to describe clinical and etiological spectrum of seizures in later life. Methods: This retrospective study was conducted from medical records of 227 cases of elderly subjects presenting with seizure to emergency department, during a period of 3 years (2010)(2011)(2012)(2013). Results: Most common age group involved was 65-75 years. Mean age of subjects included in the study was 68.13 ± 23.38 years. The most common etiology was cerebrovascular disorders 132 (58.14%), followed by CNS tumor in 16 (07.04%), hypoglycemia in 14 (06.16%), infections 14 (06.16%), substance abuse 12 (05.28%) and trauma 10 (04.40%). The most common presentation was with focal seizures, with 119 (52.42%) subjects whereas 82 (36.12%) presented with generalized tonic clonic seizure, 20 (08.81%) with generalized tonic seizure and 05 (02.20%) with absence seizures. Conclusion: The present study aims at pointing out the different clinical features and etiologies of geriatric seizures, thereby lets the reader have a head start with the management of an elderly patient presenting with seizure.

Fluctuating Neurologic Symptoms in a Patient With Brain Lesion

“…This case was in older age with misleading symptoms dissimilar to classic ones, e.g., defective visual field and fluctuating ataxia. New onset seizures in adulthood should not be overlooked because there may be usually an important lesion in the brain as its etiology especially vascular malformation [6,8]. Selective imaging in this lesion includes brain MRI and CT angiography [1,9].…”

Association between Risk Factors and New-Onse Seizures in Old Age Population

“…New-onset seizures in elderly people often has an underlying etiology, including cerebrovascular diseases, primary neuron degenerative disorders, intracerebral tumors and traumatic head injury [5]. Stroke and other cerebrovascular diseases are the most important risk factors for new-onset epilepsy and seizures in the elderly, which account for 30%-50% in all identified etiologies [61][62][63]. Stroke is an important cause of epilepsy and seizures [64].…”

The causes of new-onset epilepsy and seizures in the elderly

“…Stroke and other cerebrovascular diseases are the most important risk factors for new-onset epilepsy in the elderly, which account for 30%–50% in all identified causes. 10 , 15 – 17 In general, epilepsy can occur at the time or after stroke, or can be an early clinical manifestation of cerebrovascular diseases. Studies have reported that the risk of developing epilepsy in the first year after a stroke increases by 20 times.…”