Epilepsy in old age: causes and manifestations

Epilepsy is a common neurological disease that is diagnosed in old age at least as often as stroke. The course of this pathology among elderly people is especially dangerous, since the body is more susceptible to influence, attacks are formed much more often. It is almost impossible to predict epileptic seizures. 

Diagnostic tests and studies of epilepsy in elderly patients are lacking. It is not easy to diagnose this diagnosis among people of this age group. It will take many years of experience to determine the etiology of the disease, the stage and form of epilepsy, and the possible risks. Only a qualified epileptologist can choose the correct method of treating the disease.

Despite the fact that the number of patients with epilepsy is increasing every year, little attention is paid to the study of this problem. One and American research center examined the topic of this pathology among the elderly. Cerebrovascular and neurodegenerative disorders have been investigated , which are believed to be the etiological causes of epilepsy. Also, the researchers drew attention to the methods of diagnosis in this age group, to the methods of treatment.

Epidemiology

The incidence of epilepsy has a number of factors that could trigger its development. According to epileptologists, the disease is characterized by the presence of a bimodal nature. Most often, such a diagnosis is made to newborns and young children, as well as elderly people over the age of 60. According to medical statistics, epilepsy is most often diagnosed among elderly people. In such a group of patients, convulsive seizures appear that were unprovoked. Sometimes pathology is associated with acute processes in the body.

According to the data obtained, the first convulsive seizure among the elderly was recorded in 136 cases among 100 thousand studied. Active epilepsy among the elderly is observed in 1.5%. Among patients who are in a nursing home, the active form is observed in 5%. The prevalence of this pathology is growing every year.

It is extremely difficult to diagnose epilepsy in old age. To establish an accurate diagnosis, the attending physician fully examines the patient’s history, analyzes the frequency and nature of complaints. The testimonies of eyewitnesses who may have been present during epileptic seizures are also taken into account. Most often, seizures begin when the disease progresses. It is likely that the prevalence rates of epilepsy among people over 60 years of age are lower than the data that are reported. However, the prevalence of the disease among this population group is much higher than among young people. The indicator is twice as high.

Causes

In most cases, epilepsy in the elderly is caused by primary neurodegenerative and cerebrovascular diseases, the presence of neoplasms in the brain, and head trauma. In 50% of cases, it is impossible to determine the cause of the disease. The form of epilepsy, in which the cause of the development has not been established, is called cryptogenic.

Cerebrovascular pathology

According to medical data, often the development of epilepsy is triggered by a stroke. It is this diagnosis that becomes the main cause in 50-70% of cases. Post-stroke epilepsy develops within a few months after a stroke. In the first year after the incident, the risk of developing seizures increases 20 times. An epileptic seizure can occur many years later.

In 80% of cases, epilepsy occurs precisely after a hemorrhagic stroke. After the ischemic form of neurological pathology, seizures occur only in 5% of cases approximately one and a half to two weeks after the incident. When diagnosing the body of an elderly person after an attack, factors are assessed that could affect the appearance of a symptom. A comprehensive assessment of cerebrovascular factors is being carried out.

Neurodegenerative Disorders

The risk of developing epilepsy increases if the patient suffers from neurodegenerative pathologies, including Alzheimer’s disease and others. Such disorders and other dementias occur in up to 20% of cases among the elderly. Studies have shown that it is Alzheimer’s disease that has the greatest effect on the body. The risk of epilepsy increases if the disease was transferred at a young age. With this diagnosis, various types of seizures are possible, including myoclonic seizures.

Injury

Old age is the main risk factor for the formation of post-traumatic epilepsy. In 20% of cases, neurological pathology occurs among the elderly after a head injury. This is a fall from a height in which damage occurred.

An increased risk of developing post-traumatic epilepsy appears in the following cases:

• loss of consciousness;
• amnesia for more than a day;
• fracture of the bones of the skull;
• contusion of the brain;
• subdural hematoma;

Head injuries in old age are more serious than for young people. The risk of subdural bleeding increases , especially if treatment with platelet aggregation inhibitors or treatment with anticoagulants is carried out.

Tumors

Seizures can become a symptom that indicates the presence of a neoplasm among any age group. Seizures are characteristic of the formation of poorly differentiated primary tumors, and not for highly differentiated ones. Older people often suffer from meningiomas , gliomas, and metastatic tumors that can cause seizures.

Often, seizures indicate the development of metastasis. According to the data obtained after the study, it became known that in 43% of cases, metastases were found in patients, the cause of which was the attacks. Basically, before the onset of epileptic seizures, malignant formation is not detected.

Mental illness

People with epilepsy often have a history of mental pathologies. Constant stress, depression, emotional stress can provoke neurological disease. Epileptologists often question whether mental disorders are predisposing factors for the development of epilepsy or are independent risk factors.

In 2009, a special study was carried out in which veterans of the control group and veterans with epilepsy, which was diagnosed for the first time, took part. As a result, the researchers proved that anxiety, depression, and alcohol abuse are common among patients with a newly diagnosed diagnosis.

After that, scientists looked at risk factors such as head trauma and stroke, dementia, brain tumors and proved that only psychosis is associated with epilepsy. There is no 100% guarantee that the tests are diagnostically accurate. Among elderly patients, there is a relationship between mental disorders and epilepsy, but they do not always become the main factors that provoke the development of the disease.

It is also known that the veteran group did not include a representative population of the elderly. In the future, researchers will conduct research that will prove or disprove a possible link between mental disorders and epilepsy.

Other reasons

Among elderly patients, epileptic seizures are provoked. Seizures are of an acute symptomatic nature, it is impossible to interpret the causes of development. There are such possible causes of the onset of the disease:

• electrolyte and metabolic disorders ( hypocalcemia , hypomagnesemia , hyponatremia);
• alcohol withdrawal;
• infectious pathologies of the nervous system;

Some drugs in this age group can significantly lower the seizure threshold. These drugs include ” Tramadol ” and others. Elderly people are sensitive to the epileptogenic effects of the following drugs:

• antipsychotics;
• antidepressants, including tricyclic;
• antibiotics;
• thiazide diuretics;

Even herbal medicines have been shown to lower the seizure threshold. These include ginkgo biloba .

Clinical manifestations

Epileptic seizures are more tolerated in old age than among younger people. Epilepsy is less severe. Most often, complex partial seizures are observed , which complicate the diagnosis at the initial stage. In patients of this age category, an extratemporal epileptic focus is diagnosed. Rarely, typical olfactory foci of an epileptic seizure are found, which are mainly characteristic of young people.

If symptoms are observed, which are called the so-called “harbingers” of an epileptic seizure, then they include constant dizziness. There are also short-term loss of consciousness, impaired perception, memory lapses, problems with coordination and attentiveness. Both young and old people show signs such as tongue biting, fractures and dislocations. The post – attack period lasts from one to several days.

Epileptiform conditions

Diagnosis of epilepsy in old age requires a lot of effort and attention of doctors and is often considered incorrect. Very often, epilepsy is confused with other diagnoses that have similar symptoms. The attending physician is obliged to study the patient’s history, conduct a complete diagnostic study and pay attention to concomitant pathologies.

Some signs and clinical situations at this age mask epilepsy. For example, during falls, fainting conditions, a person does not know about the development of epilepsy. We are also talking about such signs as heart fainting, arrhythmias, disturbed sleep and memory loss.

Heart rhythm disorders

Cardiac arrhythmia is a common complaint in old age, which poses a threat not only to health, but also to the patient’s life. It manifests itself as a sudden loss of consciousness and other signs of the cardiovascular system. Arrhythmia is short-term and long-term. This pathology is not always associated with chronic fatigue. Arrhythmia often occurs for no apparent reason. The increased risk of cardiac arrhythmia is increased in the case of ventricular tachycardia and coronary artery disease. In such cases, the work of the heart is disrupted.