Liam Butler interviews Epilepsy Information & Support Specialist Lynne Stewart
Epilepsy is a common neurological condition affecting between 1% and 2% of the population. In people over 65, epilepsy is the third most common neurological disorder after dementia and stroke.
It’s common for older adults in their seventies and eighties, and even in their sixties, to feel confused, forgetful, or like they lost a couple of minutes and can’t remember what happened. But that’s not a normal part of aging. Often, it can be a sign of epilepsy.
Epilepsy can be very difficult to diagnose, particularly if the seizures are only minor, such as focal seizures, and not recognised as a seizure. One of the most important factors for diagnosing epilepsy is a good description of the seizure/event.
The description details will include:
- What happened prior to the seizure? This helps determine if there was a cause or ‘trigger’
- Was the person unwell prior to the seizure?
- What was the person doing immediately before the seizure?
- What call your attention to the seizure?
- What did the person do during the seizure?
- How long did the seizure last?
- How did the person appear after the seizure?
- How long did they take to recover fully?
- How were they feeling after the seizure?
- Were they confused?
- Could they respond to you?
Often with seizures, there is confusion, tiredness and sometimes pain or headache afterwards. Recovery can take several minutes to hours.
The doctor may take a detailed medical history and may order tests such as:
- EEG (electroencephalogram) which records the electrical activity of the brain.
- MRI (Magnetic Resonance Imaging) or CT scans that will show detailed images of the brain.
- Blood tests that may indicate other reasons that contributed to seizures such as a chemical imbalance or deficiency, abnormal blood sugar levels or infection.
The increase in prevalence of epilepsy among older adults may be due to other health problems that older adults frequently experience. For example, seniors are at an increased risk of stroke and heart attack, both of which can damage the brain and cause epilepsy. These degenerative diseases damage the brain, and very often, result in seizures.
Other diseases common in seniors that increase the risk of epilepsy include: Diabetes, Alcoholism, Liver disease, Kidney disease, High blood pressure, Tumours in the brain, and Heart disease
Seizure symptoms in older adults aren’t that different from seizure symptoms in any other age group. But while it may seem strange for a 20 year old to blank out for a few minutes and not remember what just happened, a senior might wave it off as fading memory or just getting older. As a result, this important seizure warning sign often goes unnoticed in older adults.
Other overlooked signs of seizures in older adults include:
- Experiencing a feeling of foreignness or confusion in places the person knows well
- Hearing voices, hallucinating, or seeing people who aren’t really there (maybe a loved one who has passed away)
- Feeling or acting confused
- Temporary changes in behaviours, like running, undressing, screaming, or acting very afraid
- Odd repetitive actions like chewing, mumbling, fussing over clothes, or even wildly moving arms and legs
- Staring into space
- Seeming unaware or out of it for a period of time
- Temporary problems with language
- Feeling dizzy
- Mumbling to him or herself
Some of the symptoms may be confused with signs of mental illness or dementia.
There are many types of seizures. The different types begin in different areas of the brain and they are grouped into two categories: focal and generalised.
Focal seizures – retaining awareness
These seizures are often termed an ‘aura’ or’ warning’. There is no loss of consciousness or awareness.
Focal seizures – altered awareness
These seizures were formally called complex partial seizures. They can vary greatly, depending on where they start and spread within the brain. Many of this type of seizure begin with a vacant stare, loss of expression or a vague confused expression. Awareness is altered and the person may not respond.
There are a number of kinds of generalised seizures. These occur when the seizure activity involve both hemispheres of the brain.
In many cases, seizures in seniors can be well controlled. Antiepileptic medications are generally effective in controlling epilepsy.
Due to the number of different types of seizures, there are many different medications. Monotherapy (treatment with one drug) is preferable in the treatment of epilepsy but sometimes more than one drug, or polytherapy, is required. Epilepsy is easier to live with when you understand it. Visit www.epilepsy.org.nz to learn more, become a member or make a donation.