Epilepsy in elderly often not recognised

Epilepsy is most common among people over the age of 75, however little research has been carried out within this age group and epileptic seizures are often mistaken by doctors for something else, new research has found.

Epilepsy is caused by abnormal electrical impulses in the brain and is characterised by recurring seizures. Up to 40,000 people in Ireland are thought to have the condition.

According to German researchers, the condition was long thought to be a disease of infancy, childhood, adolescence and young adulthood. However studies have shown that it is most common among people over the age of 75 and is in fact the third most common type of brain disease in old age, after stroke and dementia-related conditions.

The team analysed research in this field that was carried out between 1949 and 2008. They found that both the general public and members of the health profession ‘have an inadequate appreciation of epilepsy in the elderly’.

They noted that while the condition is almost always symptomatic in older people, ‘epileptic seizures are often not recognised in elderly patients and are instead misdiagnosed as mental changes of uncertain origin, confusion, syncope (fainting), memory disorders, or vertigo’.

The researchers also noted that auras are rare in older patients. An aura is a sensation that some people with epilepsy experience before a seizure starts. It is a type of warning for the person and for some, it can happen far enough in advance to give the person time to lie down and prevent injury from falling. Types of aura vary, but can include a change in body temperature, a strange taste or smell, a feeling of tension or a visual disturbance.

The lack of an aura makes epileptic seizures more difficult to recognise and classify, and is one of the reasons ‘epileptic seizures in the elderly often remain undiagnosed’.

Meanwhile confusion after a seizure may last longer in older patients with epilepsy, ‘giving the impression of dementia or stroke’, the researchers said.

According to the findings, drug treatment of old patients with epilepsy is complicated and there has not yet been enough research carried out in this area. For this reason, many therapeutic decisions are based on experiences with young people with epilepsy.

Furthermore, as old patients often require different drugs for a variety of diseases, drug interactions may occur. Moreover, older patients can react more sensitively to drug side-effects.

The researchers from the Epilepsy Centre of Johannes Gutenberg University in Mainz, emphasised that many questions in relation to treatment ‘cannot be answered with the current state of knowledge and the available studies’.

“Epilepsy is often more difficult to recognise in old age. The treatment is hampered by side effects and drug interactions. Thus, certainty about the diagnosis is indispensable, and the treatment often requires the use of newer-generation antiepileptic drugs,” they concluded.

Details of these findings are published in the German journal, Deutsches Ärzteblatt International.

For more information on epilepsy, see our clinic at…http://www.irishhealth.com/clin/epilepsy/index.html

[Posted: Mon 16/03/2009]