Magazine article Clinical Psychiatry News

New-Onset Epilepsy Mimics Dementia in the Elderly

Magazine article Clinical Psychiatry News

New-Onset Epilepsy Mimics Dementia in the Elderly

Article excerpt

BOSTON -- Epilepsy in the elderly often presents as complex partial seizures that can resemble sudden-onset dementia, A. James Rowan, M.D., said at a meeting on epilepsy in the elderly sponsored by Boston University.

The incidence of new-onset seizures begins to climb when patients are in their 50s after a decline that begins in childhood and reaches a nadir around age 30, said Dr. Rowan, professor of neurology at the Mount Sinai School of Medicine in New York.

By age 60, the incidence of epilepsy reaches 40 new cases per 100,000 per year, Dr. Rowan said, citing data from W. Allen Hauser, M.D., professor of neurology and neuroepidemiology at Columbia University, New York. The incidence begins an almost exponential climb to age 75, when it hits 139 new cases per 100,000 per year, which is higher than the incidence of epilepsy in infants and children up to age 3.

"Epilepsy is, in fact, a disease of the very young and the very old," Dr. Rowan said.

Yet epilepsy in elderly patients is often quite different from that in children, who typically have generalized tonic-clonic seizures. In the elderly, complex partial seizures are the norm.

Dr. Rowan described the case of a 72-year-old woman whose treatable epilepsy was misdiagnosed as worsening dementia. She was about to be sent to a nursing home.

The woman was admitted to the hospital for a dementia evaluation. She reported having "fuzzy" periods. Her past medical history was unremarkable. A CT scan showed atrophy. ECG and lab results were negative. …

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