Changing presentation of seizures with aging: clinical and etiological factors.
BACKGROUND
The historically higher incidence of seizures in children has changed, the elderly now have a higher incidence than any age-group, 2-3 times of that found in children. Classical teachings on etiologies, clinical presentation and progression of seizures are based on observations of a younger population and need to be revised in view of features unique to this age-group. The findings of two large VA cooperative studies show that even in sophisticated medical environments, up to 30% of patients 60 years and older with recurrent partial seizures go undiagnosed for more than 1 year of seizure onset.


OBJECTIVE
(a) To characterize the manifestations of auras, seizures and postictal states in the elderly and the relevance of various etiologies to these presentations. (b) To identify and discuss factors that contribute to the difficulties in the diagnosis of seizures in this population.


METHODS
A review of our experience in treating a large population of elderly patients in a university epilepsy center and a review of the literature relating to the problem.


CONCLUSIONS
Seizures in the elderly are both overdiagnosed and underdiagnosed: either situation can have serious adverse consequences. Diversity of etiologies and atypical presentations make recognition of seizures difficult. Histories are frequently inadequate: complaints of multiple physical symptoms confuse the picture, unwillingness of elderly patients to admit to problems they believe are physiological in nature by the fear others may think they are 'losing their mind' and high staff turnover result in erratic identification of problems. The significant morbidity and mortality associated with poorly controlled seizures in this population are in large part preventable since excellent response to treatment can be achieved in more than 80% of individuals. The correct diagnosis of seizures is more likely if both physician and patients are familiar with the nuances of epilepsy in the elderly.
DeToledo
J C
JC
University of Miami, FL 33136, USA.
D000368:Aged; D000375:Aging; D001921:Brain / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology*; D004827:Epilepsy / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D012640:Seizures / Q000139:chemically induced / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013226:Status Epilepticus / Q000175:diagnosis / Q000503:physiopathology