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Changing presentation of seizures with aging: clinical and etiological factors
1University of Miami, FL 33136, USA.
Insights
Elderly individuals now have a higher incidence of seizures than children. Recognizing and diagnosing seizures in older adults is challenging due to atypical presentations and diagnostic difficulties, necessitating updated clinical approaches.
Area of Science:
- Neurology
- Geriatric Medicine
- Epilepsy Research
Background:
- The incidence of seizures has shifted, with the elderly now exhibiting a higher rate than children.
- Classical epilepsy knowledge, based on younger populations, requires revision for elderly patients.
- A significant percentage of elderly patients with recurrent partial seizures remain undiagnosed for extended periods.
Purpose of the Study:
- To characterize seizure manifestations (auras, seizures, postictal states) and etiologies in the elderly.
- To identify diagnostic challenges specific to seizure recognition in the geriatric population.
Main Methods:
- Review of clinical experience with elderly epilepsy patients at a university center.
- Comprehensive literature review on epilepsy in the elderly.
Main Results:
- Seizures in the elderly are frequently overdiagnosed or underdiagnosed, leading to adverse outcomes.
- Diverse etiologies and atypical presentations complicate seizure recognition.
- Inadequate patient histories and patient reluctance to report symptoms contribute to diagnostic delays.
Conclusions:
- Effective treatment for elderly epilepsy patients is achievable in over 80% of cases.
- Familiarity with the unique aspects of epilepsy in the elderly improves diagnostic accuracy.
- Accurate diagnosis and management of seizures in the elderly are crucial for preventing morbidity and mortality.
Background:
The historically higher incidence of seizures in children has changed, the elderly now have a higher incidence than any age-group, 2-3 times of that found in children. Classical teachings on etiologies, clinical presentation and progression of seizures are based on observations of a younger population and need to be revised in view of features unique to this age-group. The findings of two large VA cooperative studies show that even in sophisticated medical environments, up to 30% of patients 60 years and older with recurrent partial seizures go undiagnosed for more than 1 year of seizure onset.
Objective:
(a) To characterize the manifestations of auras, seizures and postictal states in the elderly and the relevance of various etiologies to these presentations. (b) To identify and discuss factors that contribute to the difficulties in the diagnosis of seizures in this population.
Methods:
A review of our experience in treating a large population of elderly patients in a university epilepsy center and a review of the literature relating to the problem.
Conclusions:
Seizures in the elderly are both overdiagnosed and underdiagnosed: either situation can have serious adverse consequences. Diversity of etiologies and atypical presentations make recognition of seizures difficult. Histories are frequently inadequate: complaints of multiple physical symptoms confuse the picture, unwillingness of elderly patients to admit to problems they believe are physiological in nature by the fear others may think they are 'losing their mind' and high staff turnover result in erratic identification of problems. The significant morbidity and mortality associated with poorly controlled seizures in this population are in large part preventable since excellent response to treatment can be achieved in more than 80% of individuals. The correct diagnosis of seizures is more likely if both physician and patients are familiar with the nuances of epilepsy in the elderly.