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

Hyunmi Choi, MD, MS
Anil Mendiratta, MD
Section Editors
Timothy A Pedley, MD
Kenneth E Schmader, MD
Deputy Editor
Janet L Wilterdink, MD


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".)


The incidence and prevalence of epilepsy increase with age in adulthood and are highest in patients over 65 years. In population-based studies, the incidence rate of new-onset epilepsy in older adults ranges from 1 to 3 per 1,000 person-years [5-13]. The prevalence of epilepsy in older adults is approximately 2 to 5 percent [11,13].

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]. This trend has been confirmed in other studies [13].

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Literature review current through: Nov 2017. | This topic last updated: May 12, 2017.
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