Dr. Megdad Zaatreh is a board-certified neurologist and epileptologist and serves as medical director of the Comprehensive Epilepsy Center at CentraState Medical Center in Freehold, New Jersey. Dr. Zaatreh has published multiple research articles in peer-reviewed medical journals, including the New England Journal of Medicine, Neurology and Epilepsia. He contributed this article to Live Science's Expert Voices: Op-Ed & Insights.
After a certain age, most people experience those momentary lapses where they "space out" for a minute in mid-sentence or just draw a blank about a task they just completed. As a neurologist, I see many senior patients who worry that these bouts of mental confusion could be symptoms of dementia or Alzheimer's disease.
But rarely do older men and women realize these senior moments may be partial (mini) seizures as a result of epilepsy, diagnosed after two or more unprovoked seizures separated by at least 24 hours. Some people are diagnosed with this disease after age 60, even when they never had seizures earlier in life. [What's the Difference Between Alzheimer's Disease and Dementia? ]
Why seniors have seizures later in life
About 3 million Americans are living with epilepsy, and about 300,000 of those individuals are seniors. It is the third most common neurological disorder in the elderly after stroke and dementia, with the onset of epilepsy being most common after age 60.
Abnormal aging of the brain can be triggered by vascular, inflammatory and lifestyle factors. In many cases, the onset of epilepsy late in life is the result of neurological illnesses from other disorders — mini-strokes or strokes, tumors, heart attacks and, ironically, Alzheimer's disease — because they disturb the normal functions of the brain.
About 33 percent of all senior epilepsy cases are caused by stroke, the most common cause of seizures in older adults, followed by Alzheimer's disease.
There are also several chronic and degenerative diseases that can damage normal brain function and increase risk of epilepsy:
- Liver disease
- Kidney disease
- High blood pressure
- Tumors or injuries in the brain
- Heart disease
- Being an older adult who has undergone surgery
However, it's important to note that diagnosed epileptic seniors are not at higher risk for other neurological disorders such as Parkinson's disease, multiple sclerosis or dementia.
Warning signs may be subtle
Seizure symptoms in older adults are essentially the same as other age groups. But when seniors blank out for a few minutes and can't recall what just happened, they may just brush it off as a "sign of old age." As a result, this important seizure warning sign can go unnoticed in older adults. [10 Everyday Things that Cause Brain Farts ]
A complex partial seizure often presents with less dramatic physical signs in comparison to a grand mal seizure, where the patient exhibits a loss of consciousness and violent muscle contractions. The event can be brief as 60 seconds in duration.
Most common in seniors, a partial seizure begins with an electrical discharge in one specific area of the brain — a discharge that does not result in the loss of consciousness — but may present with some brief involuntary jerking. Additionally, the patient may experience symptoms such as temporary emotional instability; changes in the way things look, smell, feel, taste or sound; or feel tingling or dizziness.
The challenge of an accurate diagnosis
A key obstacle to confirming epilepsy in older adults is the failure to recognize symptoms that can often overlap with other neurological conditions. Diagnosis is generally determined by the use of these five tools:
- A detailed patient history
- Clinical examination (detailing a moment-by-moment seizure history)
- EEG (electroencephalography) to measure brain waves and exclude subtle seizures
- Cardiovascular evaluation
- Lab testing, including EKG, MRI and blood work-up
Once a neurologist or epileptologist has diagnosed the disease, medication therapy usually begins immediately. However, this process is not a one-size-fits-all blanket prescription, because many seniors are already taking medications to regulate other medical conditions. Doctors need to carefully weigh the risks of certain drug interactions and other potential side effects when anti-seizure medication is combined with other prescribed drugs. Most seniors, around 60-70 percent, will achieve seizure control with medication and up to 80 percent who respond to the medication will remain seizure-free.
The importance of seizure management
The root cause of epilepsy is often unknown, but seizures associated with this condition can be prevented if you know what triggers them. Many people are able to see a correlation to certain behaviors such as emotional issues, substance abuse, sleep problems, sensory overstimulation, hormonal issues (pregnancy or menstruation in women) and not taking prescribed anti-seizure medication. Keep in mind, it is not always possible to identify what can initiate a seizure — sometimes they occur for no apparent reason.
Falling is a double-edged sword for seniors living with epilepsy. While this age group is more likely to sustain falls and experience resulting head injuries, falling can also trigger seizures. In addition, people over 60 may be dealing with other medical conditions such as heart disease, diabetes or dementia. In this case, it is critical for epileptic patients to take all measures to control seizures. If seizures are allowed to continue they may accelerate memory problems and cognitive decline in this already vulnerable population.
Keep in mind, most states will not issue a driver's license to someone with epilepsy unless that person provides documentation that he or she has not had a seizure for a specific amount of time. This can restrict mobility of a senior who lives alone. Even faced with such obstacles, many of my older patients with epilepsy are able to function normally and independently.
As with all serious medical conditions, the severity of any condition dictates the level of independence a patient can safely sustain. Seniors, in partnership with spouses, family members and their medical care teams, should work closely together to establish an environment for the affected person that will offer the safest and highest quality of life possible.
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