Seizure disorders in people over 65

The annual incidence of seizure disorders (epilepsy) in those over 60 years is rising, and 25% of new cases of epilepsy occur over the age of 65. The cause of epilepsy can be identified in more than 50% of older patients.

The incidence of secondary epilepsy in the elderly has now risen to more than 100 per 100,000, and the main causes of secondary epilepsy are: cerebro-vascular disease (around 50% of cases), brain tumour, injury and bleeding on the brain (sub-dural haematoma), and degenerative conditions of the central nervous system, including Alzheimer’s Disease.

Strokes are more likely to occur in older people, and in the first year following a stroke, 5% have seizures. Because of the common factor of cerebro-vascular disease in this older age group, 3% of stroke patients also have a history of fits.

Older people have a lower threshold for developing seizures in response to a stimulus than younger people, and there is an increased likelihood of relapse.

As well as differing in causation, incidence and prevalence from those of young adults or children, seizures in the elderly differ in presentation, and predominant types of fit. It is harder to differentiate for instance between a faint (syncope) and a fit in the elderly; and complex partial status epilepticus may present as confusion.

Older people are more at risk of losing their quality of life and independence with epilepsy, and are more susceptible to injury and broken limbs because of their increased general frailty, osteoporosis, and relative immobility, for example.

All anti-epileptic medications have side effects, and, with an older person, several factors are particularly important, including his/ her state of health, the presence of other conditions, (such as heart failure) and other medication which the patient is taking. However, it is possible to control 70% of fits in the older age group.

Many elderly people are still driving, and the same driving regulations apply.

Amended November 2008