Epilepsy in Older Adults
Epilepsy is more common in older adults than many people realize. In this Clinicians Corner blog post, learn what seizures can look like later in life and how diagnosis and treatment can help people live safely and independently.
What is epilepsy?
- Seizures are a result of brain cells sending out abnormal bursts of electrical activity.
- Epilepsy means having repeated seizures that are not caused by something temporary (like low blood sugar or an infection).
- Non-epileptic events look like seizures but don’t involve abnormal brain activity. These can be fainting spells, migraines, sleep problems, or other medical issues.
How common is it?
- Epilepsy is one of the most common brain conditions in older adults, after stroke and dementia.
- It becomes more frequent after age 65, and the number of people affected is rising as the population ages.
Why is it a concern for seniors?
- Seizures can cause falls, injuries, and loss of independence.
- Older adults often take multiple medications, which can interact and make treatment tricky.
- Their bodies are more sensitive to side effects, so doctors must be extra careful with prescriptions.
What causes seizures in older adults?
- The most common identified cause is stroke.
- Other causes include brain tumors, Alzheimer’s disease, head injuries, infections like meningitis, or chemical imbalances in the body.
- Sometimes, seizures are triggered by alcohol, medication withdrawal, or organ problems (like kidney or liver failure).
How do seizures look in seniors?
- They may not look like the dramatic convulsions people imagine.
- Instead, symptoms can be subtle: confusion, memory lapses, fainting, or loss of awareness.
- Recovery after a seizure can take longer in older adults.
How is epilepsy diagnosed?
Doctors rely on:
- A detailed history of symptoms
- Physical and neurological examination
- Brain scans (like MRI and/or CT scan)
- EEG (a test that measures brain electrical activity)
- Sometimes, longer monitoring with video and EEG is needed to tell seizures apart from other conditions.
How is it treated?
Usually, doctors don’t start long-term medication after just one seizure, unless there are strong risk factors (like abnormal brain scan, EEG or repeated seizures).
When treatment is needed:
- The goal is one medication at the lowest dose that controls seizures with minimal side effects.
- Doctors increase doses slowly to avoid problems.
- Other options include surgery, nerve/brain stimulation, or special diets.
Can epilepsy be controlled?
Yes. Most older adults can become seizure-free with the right treatment.
Authors:
Rupert Exconde, MD
Anna Shukla, DNP
Minneapolis VA Health Care System