Seizure disorders of aging: differential diagnosis and patient management

The incidence of seizures increases significantly after age 60, mainly because of an associated rise in the prevalence of such etiologies as stroke, brain tumors, and toxic-metabolic disturbances, including alcohol or drug misuse and diabetes. The differential diagnosis must rule out transient ischemic attacks, syncope, and psychiatric disorders, among other conditions. Treatment is based on the underlying cause. Seizures caused by toxic-metabolic disturbances are treated by correcting the underlying condition. Those with other etiologies require single-drug therapy with an anticonvulsant, such as phenytoin, valproic acid, or carbamazepine.