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Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis

Authors
Hyunmi Choi, MD, MS
Anil Mendiratta, MD
Section Editors
Timothy A Pedley, MD
Kenneth E Schmader, MD
Deputy Editor
April F Eichler, MD, MPH

INTRODUCTION

A significant proportion (nearly 25 percent) of new onset seizures occur in individuals over the age of 65 years [1,2]. The causes and clinical manifestations of seizures and epilepsy differ in this age group and affect the diagnostic approach. Treatment decisions can be complex in older patients, who have increased susceptibility to side effects and an increased likelihood of multiple medical comorbidities. A seizure diagnosis has significant quality of life implications in older patients, who are already vulnerable to loss of independence, driving restrictions, impaired self-confidence, and risk of falls [3,4].

Acute symptomatic seizures are provoked events that are not expected to recur in the absence of a particular trigger (eg, hypoglycemia, alcohol withdrawal). Epilepsy is a condition in which recurrent unprovoked seizures are expected in the absence of treatment. This topic will cover the etiology, clinical presentation, and differential diagnosis of seizures and epilepsy in older patients. The treatment of seizures and epilepsy in the older patients is discussed separately. (See "Treatment of seizures and epilepsy in older adults".)

EPIDEMIOLOGY

The incidence and prevalence of epilepsy increase with age in adulthood and are highest in patients over 65 years. In Rochester, Minnesota, the reported incidence of new-onset epilepsy was 134 cases per 100,000 older adults [5,6]. Similar rates are reported in other populations [7-11]. One study estimated the prevalence of epilepsy to be almost 9 per 1000 individuals over the age of 65 years [12].

The annual incidence of epilepsy rises with each decade over 60 years (figure 1). Seizures in older patients are frequently underdiagnosed; hence, the incidence of epilepsy in older patients may be two to three times higher, with an incidence six to seven times greater than younger individuals [1].

Among US Medicare beneficiaries age 65 years and older, average annual incident rates in 2001 to 2005 were highest in African Americans (4.1 per 1000) and lowest in Asian and Native Americans (1.6 and 1.1 per 1000), in comparison to whites (2.3 per 1000) [11].

                             

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Literature review current through: Nov 2016. | This topic last updated: Fri Jul 15 00:00:00 GMT+00:00 2016.
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