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Epilepsy and the elderly

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By Professional Advisory Board Member Ilo Leppik, M.D.

 

Seizures are more likely to start after age 65 than at any other time in life. Because the number of persons in this age group is increasing rapidly, there will be an increase in the number of persons with seizures in the coming years. Seizures can happen for two main reasons. One is that there is something in the brain that triggers seizures. The other is that some other cause outside of the brain sets off a seizure. That is why it is important to get a person who has not been diagnosed as having epilepsy to an emergency facility after a seizure. There it can be determined if the seizure was caused by something like heart trouble, low blood sugar, an infection or other conditions. A seizure caused by low oxygen to the brain from a heart problem or other condition not directly affecting the brain is not considered to be epilepsy. The condition that caused the seizure needs to be treated but antiepileptic drugs are not needed.

Many seizures in the elderly are associated with a problem in the brain. Usually epilepsy is defined as two or more seizures. A common cause of seizures is a previous stroke. Overall, from 30% to 40% of all seizure cases in the elderly are in persons who have had a stroke. The eventual risk of experiencing seizures after suffering a stroke may be as high as 20%. Brain tumors, head injury, and Alzheimer’s disease are other conditions of the central nervous system that predisposes to seizure activity in the elderly. Epilepsy is usually diagnosed and treated after two seizures have happened. But a committee of the International League Against Epilepsy  (ILAE) has proposed that epilepsy be defined as a condition of the central nervous system that predisposes one to have seizures.  This means that a person who has had a single seizure but is found to have a definite neurological condition may begin treatment to prevent more seizures. Because most seizures in the elderly are caused by a focal area of damage to the brain, the most common seizure types are localization related. Complex partial seizures are the most common seizure type, accounting for nearly 40% of all seizures in the elderly population.  Both simple and complex seizures may spread and develop into generalized tonic-clonic seizures.

Problems faced by the elderly suffering from epilepsy are different and more complex than those faced by younger adults also suffering from the same disorder. Unlike younger persons who only have epilepsy, many older persons have other medical issues. These often involve taking other medications, which can interfere with the drugs used for epilepsy. The liver processes many drugs and the doses needed may change. One example is Lipitor. Its processing can be speeded up a lot by some epilepsy drugs, making it less effective. Coumadin is especially troublesome because the dose needed to get good control over clotting can change with the addition of an anti-seizure medication. Another problem that arises is when a person with epilepsy develops another medical condition that needs medical treatment. This article is too short to list all of the medication interactions, but in general, older persons with medical problems may be better off using anti-seizure medications that are not processed by the liver but are eliminated through the kidneys. Even with these, however, one needs to measure how the kidneys work because they may slow down in older persons. An older person with epilepsy needs to be sure to explain to their doctor about all of the medicines that are taking and ask if there are any problems with them. Today, there are many computer databases that a physician and pharmacist can use to look for problem combinations.

In addition to prescription drugs, there are a number of “natural” products that can interfere with medicines. St. John’s Wort is especially troublesome because it can affect the elimination of many drugs making them much less effective. Some “natural” products used to improve memory, increase energy, or help erectile dysfunction may actually cause seizures. That is why a person with epilepsy needs to avoid these substances.

Developing epilepsy late in life can be very troubling. It is important therefore that one learns a lot about this disorder and how to best deal with it. The good news is that epilepsy that develops later in life is often easier to control with lower doses of anti-seizure medications. However, to have the best outcome, one should go to a doctor who has experience dealing with this and also work with support organizations such as the Epilepsy Foundation of Minnesota and national epilepsy groups.

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