Gerontologists urge vigilance in diagnosing increasing cases of seizures

November 22, 1999
Web posted at: 2:01 PM EST (1901 GMT)

In this story: More elderly, more seizures Spotting a seizure The seizure solution RELATEDS

By Sarah Yang

(WebMD) -- The signs are all too classic: forgetfulness, disorientation, mindless fumbling or a repetitive smacking of the lips. These symptoms are sometimes dismissed as a natural part of aging, or if severe enough, diagnosed as Alzheimer's disease or dementia, says James Rowan, M.D., professor of neurology at the Mount Sinai School of Medicine in New York.

What many physicians fail to see, says Rowan, are the possible signs of a seizure disorder -- even though the number of Americans age 60 and older developing epilepsy has increased markedly. And the problem is likely to worsen as the number of elderly baby boomers swells over the next few decades.

"It's becoming more prominent, and the consciousness of the medical community is starting to come around," said Rowan, who spoke Sunday at the 52nd Annual meeting of the Gerontological Society of America conference in San Francisco.

More elderly, more seizures

About 61,000 new cases of epilepsy are reported each year among elderly Americans. At that rate, by the year 2025 "half of all people with epilepsy will be over the age of 65," said Steven C. Schachter, M.D., chairman of the professional advisory board for the Epilepsy Foundation and associate professor of neurology at Harvard Medical School.

The medical community is only now beginning to grasp the increase of epilepsy among the elderly. "There are many unique aspects of epilepsy in this age group, and doctors are not prepared yet to effectively diagnose and treat it," Schachter said.

According to the Epilepsy Foundation, one American out of 10 has had or will have a seizure during his or her lifetime. Recurrent seizures -- epilepsy -- affect about 2.3 million people.

Spotting a seizure

Seizures occur when electrical signals in the brain fire uncontrollably. Physicians don't know what causes most seizures. But some may be linked to brain injury from head trauma, perhaps from a sports injury or automobile accident; some to infections such as meningitis, AIDS and encephalitis; and some to genetics, as with an inherited form of juvenile epilepsy.

In the elderly, stroke, cardiovascular disease, brain tumors and Alzheimer's disease can cause seizures. In addition, the wear and tear of the "aging process may predispose people to seizures," said Rowan, and the damage caused by seizures may be greater because it takes longer for the elderly to bounce back from an attack.

Neurologists say proper diagnosis is challenging because seniors typically suffer from complex partial seizures. Unlike the severe convulsions of a grand mal seizure, complex partial seizures are characterized by symptoms as subtle as incoherence or odd arm, leg or mouth movements. Some may stagger or wander about aimlessly.

So how can a doctor, much less a relative or friend, tell whether these behaviors are signs of seizures? Rowan said that keeping a detailed record of such incidents may help determine if there's a pattern to the behavior that can indicate seizures, which often manifest themselves in similar ways. Also, electroencephalograms (EEGs) and magnetic resonance imaging (MRI) scans will often detect the residual brain scarring sometimes left behind from prior seizures.

The seizure solution

Proper treatment can only begin with a correct diagnosis -- but even then elderly patients are not home free.

"The older patient doesn't tolerate medication well," said Eugene Ramsay, M.D., professor of neurology and director of the University of Miami's International Center for Epilepsy, who collaborated with Rowan on the 1996 book "Seizures and Epilepsy in the Elderly." "They may have a sensitivity to the drug, and they may be taking five, 10, even 15 other prescription drugs."

Adverse interactions are a greater problem with some of the older antiepileptic drugs, such as phenobarbital and phenytoin. They can cause drowsiness and interfere with drugs such as the blood thinner warfarin.

A new breed of treatments on the market may offer relief with fewer side effects. But neurologists acknowledge that the new medications on the block come at a price, running tens to hundreds of dollars more than their predecessors.

The best solution may still be prevention. Experts emphasize that these seizure disorders are not an inevitable part of aging. Rowan said that reducing high blood pressure, obesity and other risk factors for stroke and cardiovascular disease would also reduce the risk for epilepsy.

At the same time, Rowan called for more research into how the disorder affects the elderly. "There are a lot of things we don't know terribly well," he said. "Perceptions change slowly."

RELATEDS AT :

Epilepsy: Taming the seizures

What is epilepsy?

---

RELATED SITES:

The Epilepsy Foundation
The Gerontological Society of America

Note: Pages will open in a new browser window

External sites are not endorsed by CNN Interactive.

---

LATEST HEALTH STORIES:

China SARS numbers pass 5,000
Report: Form of HIV in humans by 1940
Fewer infections for back-sleeping babies
Pneumonia vaccine may help heart, too