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Epilepsy in Older People

Updated on January 2, 2015

When addressing this issue, I want to demonstrate that older people with epilepsy have their own specific and it is important that the health workers, who care for these people, know that is important to inform the Elderly people with epilepsy and their families and the caregivers much as possible.

In order to achieve this goal, let’s talk about this topic.

Why approach the subject Older People with Epilepsy?

The definition of epilepsy, proposed in 2005 as a condition where there is a predisposition to generate epileptic seizures, which are associated with the effects at various levels (biological, psychological and social) is very broad and includes a large number of realities and different disorders, so that it allows and makes it desirable to be individually approached more concrete themes. Only in this way it can be distinguish the significant aspects of each disease and / or each group of patients. So it begins to justify the approach to the subject "Epilepsy in Older People". It is an approach that is performed for other groups of people with epilepsy, as the "woman with epilepsy."

On the other hand, the elderly, always deserved a particular look of society, not only in health but also in other areas, as, for example, the socio-cultural level.
Moreover, if we consider the increase in the proportion of the elderly population in so-called developed societies, as well as the prediction that this proportion will continue to rise even more important it matter becomes the specific evaluation, by health professionals, the healths problems of the Elderly.

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So what is the relationship between Epilepsy and Age?

If we look at the number of new cases of epilepsy in the population per year, according to age (incidence of epilepsy by age), we realize that in Europe there are two periods of higher incidence of new cases of epilepsy: the first years of life (up to early adulthood) and in the elderly population, after 65 years. Approximately 25% of new cases of epilepsy occur in people over 60 years.

What are the causes of Epilepsy in the Elderly?

If we consider the causes in these two groups, once again we realize the existing heterogeneity in the concept of "epilepsy" as the main causes of epilepsy are different in the two groups, usually symptomatic epilepsy in the elderly to a disease of the central nervous system particularly cerebrovascular diseases (stroke) and degenerative diseases (such as dementia, particularly Alzheimer's disease) but also symptomatic of other diseases of the central nervous system as neoplastic, traumatic and infectious.

Dr Aza Abdulla Epilepsy Conference

What are the peculiarities of diagnosis?

In older people diagnosed with Epilepsy may be difficult for several reasons: firstly because the description of the seizures is more vague and its semiology something different from the crises of the young population, which is related, in part, by higher frequency of crises focal (confined to one area of the brain), some of them complex (with alteration of consciousness, which can be more or less subtle) and on the other hand, as in the case of vascular pathology by the variable location of the area that triggers the symptoms, triggering a large number of possible symptoms and signs for the seizures in the elderly.

Moreover, the fact that some elderly people living alone, reduces the possibility of a relative witness and to identify the crisis.
Furthermore, the elderly population there are several causes for the "loss of consciousness", as syncope, particularly vasovagal cause and heart, which can cause abnormal movements, that witnesses can describe wrongly as seizures. Also the confusion states related to metabolic or infectious causes imbalances can be confused and be mistaken for some types of seizures.
Moreover, not all epileptic seizure means epilepsy . Some seizures are one acute pathology and symptoms are not related to a chronic predisposition to seizures, according to the definition of epilepsy. They are called thus "acute symptomatic seizures." For example, in the case of stroke seizures occurring in the first 7 days after stroke onset are not considered indicative of epilepsy but acute symptomatic crises. The same applies in the case of crises that occur in the acute phase of traumatic or infectious disease of the central nervous system or in cases of metabolic disorders, frequent pathology in the elderly.

So as to avoid these diagnostic errors that can lead to unnecessary treatment of a disease identified by a bad part, and failure to treat a condition not identified correctly? With a careful evaluation of the clinical history, listening to the account of the Elderly, but also the family and any witnesses. With a neurological evaluation and careful overall physical and complemented the assessment with exams appropriate diagnosis, particularly the electroencephalogram in its various forms, the brain imaging and blood screening exercise and sometimes of the cerebrospinal fluid

HeadSaver for Elderly People

Though many falls are preventable, elderly people continue to fall and suffer fall related injuries. HeadSaver protect their heads.
Though many falls are preventable, elderly people continue to fall and suffer fall related injuries. HeadSaver protect their heads.

And the treatment of epilepsy? It has also specifications?

There are several definitions of aging, addressing various human areas, but referring biological aspects relate it is a normal process, non-pathological, which is associated with alterations in the functioning of various organs, often involving loss of capacity. Professionals dealing with Elderly Epilepsy is clear that several changes in the Elderly modify how the body interacts with antiepileptic drugs, that is, how the tissues, as is metabolized and excreted.
On the other hand there are antiepileptic drugs cause side effects in the body as excessive sedation, that the elderly person may be a serious compilations, such as falls and sometimes complicated major trauma (e.g., fractures).

Thus the assessment of the Elderly should be rigorous and far from beyond the control of epilepsy, involving for example the assessment of nutritional status, the risk of falls, as well as evaluating the functioning of various organs.
On the other hand, Elderly and often polimedicated due to the existence of many diseases, interaction between different drugs and antiepileptics should be considered particularly in the case of first-generation antiepileptic drugs with new antiepileptic drugs, lamotrigine and particularly when gabepentina compared with carbamazepine. Other studies evaluate the quality of other drugs as levetiracetam, and topiramate. However it would be desirable to have more studies of anti-epileptic drugs in Elderly.

The data are important for the doctor to choose the most appropriate antiepileptic drug for each patient, considering the therapeutic efficacy, the profile of side effects and drug interactions. Also, another factor to consider is the price of treatment, which is particularly important in demanding days.
Proper evaluation of this type of parameters allows for proper treatment of Epilepsy in the Elderly, and you can get the results, since that the Epilepsy, in this age group is considered easy to control.

So concludes: The Elderly people with epilepsy have their own specific and it is important that health professionals who care for these people know in order to offer a multidisciplinary care plan, which is efficient and, if possible, free of side effects in order to achieve the scientific evidence shows: usually the treatment of epilepsy in Elderly gives good results.


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