Seizures are very common in older adults.  In fact, outside of very young children, older adults often are the most frequently impacted with seizures.  Despite this fact, it is often surprising to note that many medical professionals are unaware of how common seizures are in older adults. Seizures are often overlooked and mistakenly diagnosed as other conditions that can occur in older patients.  If an individual is having events that are stereotypic --that is, identical from event to event-- with regards to how long they last and how they present, then seizures should be considered as a possibility for a diagnosis.  People who have frequent events of loss of memory, language changes, loss of consciousness, tremor, or sensory or numbness changes should consider whether they are having seizures. 

Younger individuals tend to have the most common type of epilepsy known as temporal lobe epilepsy, whereas older adults are more likely to have seizures that emanate from other lobes of the brain such as the frontal and/or parietal lobe.  Therefore, the presentation of seizures in older adults oftentimes mimics the presentation of other conditions.  In fact, the most common aura associated with older adults is that of dizziness.  However, dizziness is one of the most common symptoms for many other conditions, which can then lead to an alternative diagnosis by your physician.  Common conditions that seizures are mistaken for include: transient ischemic attacks (TIA), transient memory problems, fainting spells (syncope from low blood pressure), migraine headaches, tremors, or panic attacks.  In addition, seizures often have present in a more subtle manner than those in younger individuals.  Older adults are most likely to have complex partial seizures.  Complex partial seizures in older adults may present as confusion or memory lapse for which the person has no clear recollection of what has occurred.  Therefore, it is not that uncommon to mistake this seizure type for some other type of medical problem.

Once seizures are entertained as a possible cause of a medical problem, a number of medical tests will likely need to be done.  The simplest is a history and physical examination.    Your physician will review the events to see if they fit the typical profile for a seizure, which often lasts 60 seconds and may reoccur.    A careful assessment of your medications will need to be completed as well as any searching for medical conditions that may lead to seizures such as a stroke, tumor or other medical problems.  Sometimes diagnostic tests are done in addition to the history and physical examination.  Typically, a doctor or a healthcare professional will check a series of lab tests including glucose, sodium, liver enzymes, oxygen, a complete blood count to assess for infection, and at times other more extensive laboratory tests.  An MRI of the brain is an important part of the evaluation process.  This will give your doctor a detailed picture of the brain paying close attention to any scars, potential strokes, or any new growth that might lead to seizures.  An EEG is also commonly performed.  In this test, brain waves are recorded painlessly during both sleep and wakefulness.  Other tests include assessing the condition of the heart to make certain that there is no abnormal heart rhythm that may lead to problems that ultimately lead to a seizure.  Sometimes one cannot be certain if a particular episode or spell represents a seizure.  In those instances, a physician or healthcare professional may suggest that admission to an inpatient epilepsy monitoring unit is necessary in order to record these typical events.  It is sometimes necessary to admit people into the hospital for this purpose in order to make a clear diagnosis of what is occurring.  Other options that are also considered are ambulatory EEG recordings, in which, a patient wears a home EEG monitor and can provide up to 72 hours of recording as long as someone is willing to fill out a diary that accompanies the EEG.

It is only after these studies are completed and coupled to the history and physical examination results that one can make a diagnosis of seizures and/or epilepsy.  If indeed there is a clear diagnosis that seizures and epilepsy are occurring, then the next question that arises is whether a seizure medication should be initiated.  The answer to that question will depend on how significantly these seizures impact quality of life and how frequently these events occur. 

 

Authored by: Joseph Sirven, MD
Reviewed by: Patricia O. Shafer, RN, MN on 7/2013
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