Are Seniors at Risk for Epilepsy?
Maybe you’ve had epilepsy for decades—or maybe you’ve just been diagnosed. Either way, take a deep breath. “Most people respond well to treatment,” says Jacqueline French, M.D., professor of neurology at NYU-Langone Medical Center in New York City. “You can still lead a long, healthy life.” Three million American adults have epilepsy, a condition causing seizures that range from super-dramatic episodes that knock you off your feet to milder spells that space you out for a few moments. But how does epilepsy impact seniors specifically? Let’s find out.
First: What is epilepsy?
Epilepsy is a chronic condition marked by recurring seizures that often seem to come from out of the blue. It can affect any part of your body, but it always starts with an electrical event in your brain. Your brain has about 100 billion cells called neurons, which send electrical impulses out to the rest of your body, controlling everything from walking to thinking. Sometimes, though, those electrical signals go haywire. “You get this electrical instability that marches through your brain for a couple of minutes,” says Dr. French. That’s a seizure. Two or more seizures? That may be epilepsy.
What causes epilepsy?
For two out of three people with epilepsy, the answer is, “We don’t know.” But for some, there may be a link to another condition. “Sometimes there’s a cause for epilepsy like a head injury or a stroke,” says Dr. French. “But a lot of times in older people there are no obvious explanations. We don’t always know the answer, but we do know there’s a higher susceptibility for epileptic seizure as you age.”
When does epilepsy tend to develop in older adults?
According to the Centers for Disease Control and Prevention, one million adults over 55 have epilepsy. And your risk tends to go up with each year. “That’s because you’re more likely to have an underlying brain disease that triggers seizures,” says Barbara Jobst, M.D., director of the epilepsy program at Dartmouth-Hitchcock Medical Center in Hanover, NH. For some, epilepsy can start about six months after a stroke. And research shows that Alzheimer’s and epilepsy can occur together, too. “If you have Alzheimer’s and your brain is having a problem,” says Dr. Jobst, “it may respond by generating a seizure.”
How is epilepsy diagnosed?
It can be tricky to spot epilepsy in seniors. “When you develop epilepsy at an older age, there’s an increased likelihood of misdiagnosis,” says Dr. French. “Mild mental lapses or confusion—often all you have with a seizure—may look like dementia.” Plus, certain cardiac events or alcohol withdrawal can mimic the condition. The criteria to confirm a diagnosis: Two seizures at two distinct events, or one seizure followed by an EEG or MRI that supports an epilepsy diagnosis. For instance, there's a tumor, brain scar, or blood vessel problem that could have triggered the seizure.
What are the stages of a seizure?
Seizures all look a little different, but they have three phases no matter your age. The lead-up is called the prodrome, when some people have a sense that a seizure is coming on. Next comes the ictal phase; that’s when you feel the strongest effects of your brain’s electrical activity. Finally, there’s the post-ictal phase, when your body recovers. It may be hard to tell when one phase ends and another begins—after all, an entire seizure only lasts from a few seconds to a couple of minutes. Let’s look at each one.
What’s a prodrome?
For some people, there may be a prodrome period, often called an aura, before the full-blown seizure kicks in. Hours—or days—beforehand, they may have a feeling of déjà vu, panic, or lightheadedness. Some experience an unusual sound, smell, or taste. “Sometimes there are warning signs,” explains Dr. Jobst. “And when people have them, they can get into a safe place before the bigger seizure happens.” But often, the seizure comes from nowhere. One study showed that only about 20% of people with epilepsy experience auras.
What happens during the ictal phase of a seizure?
This is when electrical seizure activity in your brain plays out in your body. It can vary from a momentary loss of awareness or confusion to tremors, twitching, or jerking movements. “People often think of epilepsy as a ‘television seizure,’” says Dr. French, “with people salivating, shaking, rolling on the floor. But it’s often much more subtle. I tell patients to look for the Five S’s: sudden, strange, similar, short spells. Seizures can be strange movements or perceptions shorter than two minutes—that tend to be similar to one another.”
What’s the post-ictal phase?
This is the end of the seizure, when your body recovers from what it’s just gone through. That can take anywhere from minutes to hours, or sometimes even a couple of days. You might feel sleepy, sluggish, or even a bit confused or embarrassed. Some people may experience headache or nausea.
What triggers a seizure—and can I keep it from happening?
Mostly, it’s a mystery. “Seizures are often completely random—there’s usually nothing you can do to prevent one or bring one on,” says Dr. Jobst. “There’s no control and that’s frustrating—seizures happen when they want to happen.” But some people do have triggers, so pay attention to your body. “Sometimes, sleep deprivation or alcohol might trigger a seizure,” Dr. Jobst explains. “So get regular sleep and stay away from alcohol if that’s a trigger for you.”
Do seniors have special challenges with epilepsy?
One big problem: falls. “When you’re older, the impact of seizures can be greater,” says Dr. French. “People may have brittle bones and osteoporosis. So when they fall, there’s a greater chance of a fracture. And living alone makes things worse—having a seizure can be problematic when there’s nobody to check on you.” Another complication is depression, which affects as many as one in four epilepsy patients, according to one study. “One way the brain responds to disease is seizure; another way is depression,” says Dr. Jobst. “But it’s all about the same organ—your brain.”
How is epilepsy treated?
Medication can be super-effective. “About 70 percent of people respond well to anti-seizure medications,” says Dr. Jobst. There are many kinds, depending on seizure type, age, and other health conditions—if one doesn’t work, another may. But be sure to keep up with regular checkups—preferably with a doctor specializing in epilepsy. “Dosages often need to be adjusted as you age and your metabolism changes,” advises Dr. Jobst. If seizures don’t respond to medication, other options, says Dr. Jobst, include surgery or brain stimulation. One study showed that 58% of those undergoing epilepsy surgery were seizure-free after one year.
Is there life after epilepsy?
Absolutely, insists Dr. Jobst. “Having a seizure can be scary,” she admits. “But most seizures stop by themselves after seventy seconds, and then you can go back to normal. You may have to make some adjustments—you may not be able to drive, for example—but I tell my patients they can still have a good life. And people with epilepsy are not alone—every hundredth person you meet has the condition, too.”
- Simple Guide to Seizures: The Epilepsy Foundation. (2014). “What Happens During a Seizure?” epilepsy.com/learn/about-epilepsy-basics/what-happens-during-seizure
- All About Auras: Neurology. (2014). “Auras in Generalized Epilepsy.” pubmed.ncbi.nlm.nih.gov/25230998/
- Epilepsy and Seniors: Centers for Disease Control and Prevention. (2019). “Epilepsy and Seizures in Older Adults.” cdc.gov/epilepsy/communications/features/olderadults.htm
- Epilepsy 101: Centers for Disease Control and Prevention. (2019). “Frequently Asked Questions about Epilepsy.” cdc.gov/epilepsy/about/faq.htm
- Dealing With Depression: Archives of Medicine and Health Sciences. (2019). “Epilepsy and Depression: An Update.” amhsjournal.org/article.asp?issn=2321-4848;year=2019;volume=7;issue=1;spage=104;epage=111;aulast=Mula
- Treating Epilepsy With Surgery: New England Journal of Medicine. (2001). “A Randomized, Controlled Trial of Surgery for Temporal-Lobe Epilepsy.” nejm.org/doi/full/10.1056/nejm200108023450501
- Surgery for Seniors: Epilepsia Open. (2018). “Time to Push the Age Limit: Epilepsy Surgery in Patients 60 Years and Older.” ncbi.nlm.nih.gov/pmc/articles/PMC5839305/