Epilepsy is most commonly associated with children, who may suffer developmental and cognitive delays due to related brain damage, but in reality the face of epilepsy looks quite different. A full 1% of seniors have active epilepsy, including a significant number who develop the condition later in life. Unfortunately, late-onset epilepsy can be uniquely difficult to diagnose and manage, as the symptoms may mimic dementia, among other conditions widely found in the elderly.
For doctors faced with older epilepsy patients, treatment, seizure prevention, and proper differential diagnosis is vital to patient well-being. Conversely, practitioners in other specialties can help minimize new epilepsy cases through aggressive treatment of conditions such as stroke.
Differential Diagnosis Challenges
When epilepsy is depicted in the media, the emphasis is almost always on grand mal seizures, which involve loss of consciousness and muscle spasms, but these are far from the only type of seizure. The others, however, tend to be less visually dramatic and don’t provide much drama. Furthermore, because of their subtle symptoms, which may include confusion and memory loss, many patients, caregivers, and doctors assume that patients are simply experiencing normal signs of aging.
Even when physicians correctly identify epilepsy symptoms as signs of disease rather than aging, the condition is commonly misdiagnosed. Diagnosing new seizures in senior patients can be so difficult that doctors refer to a large set of epilepsy mimics. In seniors, these include hyper- and hypoglycemia, cardiac arrhythmias, syncope, and sleep disorders, among other conditions. Essentially, if a condition primarily presents as falls, fainting, memory issues, or confusion, it might be considered an epilepsy mimic.
Physicians need to aggressively examine symptoms and hold patients under observation whenever possible, as patient and caregiver reports are rarely adequate for an epilepsy diagnosis in senior patients. Caregivers should also be asked to elaborate on their descriptions of typical aging symptoms whenever possible and provided with guidelines for home use. We can’t expect family and friends to be as knowledgeable as physicians, but they are our eyes and ears on the ground when it comes to diagnostics.
Managing Aging By Managing Seizures
It’s easy for doctors to ignore late-onset epilepsy when it mimics normal signs of aging, but because both aging and seizures can contribute to cognitive decline, it’s important to differentiate between the two in order to protect cognitive function. As Dr. Rebecca O’Dwyer, a neurologist at Rush University Medical Center, explains, seizures may damage the part of the brain associated with long-term memory and “uncontrolled seizures can lead to faster decline in cognition.”
Seizures can also cause faster physical decline than is typically seen in senior patients, a fact that can be clearly extrapolated from the data on younger individuals with the condition. In one 2003 survey, 36% of California residents with epilepsy rate themselves disabled or unable to work, compared with 5% of the general population. When properly managed with medication, however, two-thirds of epileptic adults should be able to live seizure-free, according to CDC epidemiologist David J Thurman. The other third should be able to significantly minimize their seizure frequency.
If young people are significantly impaired by epileptic seizures, senior experience far greater consequences. For example, epilepsy-related falls can lead to injuries, from relatively minor sprains to broken hips in those with advanced osteoporosis. And if younger individuals struggle to remain in the workplace, seniors are more likely to face serous isolation from prior social activities, which can be harmful to their mental health.
Creating Comprehensive Care Networks
If healthcare providers are going to prevent new cases of epilepsy and manage seizures in current patients, there needs to be a greater degree of literacy around the condition across different fields. For example, emergency personnel should be well trained in code stroke systems, a rapid and aggressive treatment technique for acute ischemic strokes that can prevent new cases of epilepsy by minimizing brain damage. Since strokes are responsible for the majority of late-onset epilepsy cases, this should be considered a first line of defense.
Another important feature in epilepsy treatment, particularly in older adults, is providing access to comprehensive care. Because many other conditions can cause increased seizure activity, treating the epilepsy on its own isn’t enough. One common condition that frequently contributes to increased seizure activity is sleep apnea. Poor sleep can lower the seizure threshold, while daytime sleepiness is often attributed to seizures or epilepsy medication. By treating sleep apnea with a CPAP mask, many patients can reduce their seizure frequency.
Be Smart About Seizures
In order to understand late-onset epilepsy, we need to both recognize the wide variety of seizure manifestations and the range of potential causes. From strokes to autoimmune conditions and head injuries, new seizures in older adults can be treated or prevented – but most importantly, they must be recognized for what they are. If we attribute symptoms like memory loss, falls, and confusion to normal aging when they’re really signs of ongoing seizure activity, we allow our senior community members to flounder when we have the ability to help.
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