Seniors fastest growing group of epileptics

Washington -- When elderly people experience periods of confusion, it might signal a "senior moment." But these periods of disorientation could be a sign of epilepsy, now recognized as occurring more frequently within this population.

People older than 60 constitute the fastest growing group of those with epilepsy, with 68,000 new cases diagnosed each year, said Georgia Montouris, MD, assistant professor of neurology at Boston University School of Medicine. Approximately 15% to 18% of nursing home patients have epilepsy, she noted.

More than 300,000 Americans in their 60s, 70s and 80s have the disorder, according to the Epilepsy Foundation, and, as the population ages, its prevalence is likely to increase.

"Epilepsy is often thought of as occurring mainly in children, but it can come on at any age," said Richard Mattson, MD, professor emeritus of neurology at Yale University School of Medicine in New Haven, Conn.

Drs. Montouris and Mattson were among those speaking at a Dec. 2 briefing sponsored by the J. Kiffin Penry Epilepsy Minifellowship Program. The program, started in 1985, was created to teach neurologists about the condition.

Though common, the disorder can be mistaken for a stroke or Alzheimer's disease in older patients because, like epilepsy, both frequently trigger seizures. This circumstance adds to the complexity of diagnosing and treating epilepsy. Symptoms can range from episodes of staring or unresponsiveness to involuntary movements of arms and legs.

But not all seizures represent epilepsy, said Eugene Ramsay, MD, professor of neurology and psychiatry and director of the International Center for Epilepsy at the University of Miami School of Medicine. It can be diagnosed from the recurrence of similar seizure types, results from an electroencephalogram, a family history of the disorder and responses to medication, he said.

A variety of seizures

There are two categories of seizures: generalized, which can include sudden muscle contractions, falls and convulsions; and partial. The latter are the most common, might last five to 15 minutes and might be preceded by a feeling, or aura, of apprehension, Dr. Montouris said. They also might include repetitive movements and leave the individual feeling "sort of spaced out," she said.

An accurate diagnosis of epilepsy is particularly important among older people to prevent the recurrence of seizures.

While 40% of younger people who have a first seizure go on to have another in a year, about 75% of elderly people have a recurrence in six months and 90% have another seizure within a year, she said.

Although people don't die of epilepsy, they can be injured from falls and burns that occur during seizures. The risk of such injuries lends added importance to gaining effective seizure control, Dr. Montouris said.

Control is most frequently achieved with medication, although surgery is also an option. There are more than a dozen medications, and many work as well for older people as for younger. But, a lower dose likely will be sufficient among the elderly, Dr. Montouris said. "Older people simply don't tolerate the same level of medication that someone much younger does, and that has to be taken into consideration."

Harmful interaction between epilepsy medication and other medications that might be taken by older people is another consideration, she added.

There are many effective drugs from which to choose, Dr. Mattson said. "Several were developed in the 1990s, and all are distinctive in the way they work and how they are handled by the body."

The older medications include phenobarbital, carbamazepine, primidone and valproate. Among the newer options are gabapentin, pregabalin and topiramate.

Surgery for epilepsy typically is considered only after anti-epileptic drugs have failed and the seizures are causing neurological or physical damage, Dr. Mattson said.