Epilepsy among Older Adults Underdiagnosed, Undertreated
Aldrich, Nancy, Aging Today
Epilepsy is probably not what you think it is, especially when older adults have it. Epilepsy is beset by myths and misunderstandings:
Myth: Only children and young adults get epilepsy. Fact: The segment of the population with the fastest-growing incidence of epilepsy in the United States is older adults.
Myth: Epilepsy always causes dramatic seizures. Fact: The symptoms of seizures in older adults can be subtle and are often missed.
Myth: Put a spoon in the mouth of someone having a seizure to prevent tongue swallowing. Fact: Never put anything in the mouth of a person having a seizure, and never restrain the person.
Myth: Seizures are contagious or caused by spirits. Fact: Epilepsy is a neurological disorder. It is not contagious, not caused by spirits-a superstition still believed by some, according to a 2005 survey by the Epilepsy Foundation-and not to be feared.
What is true is that epilepsy left untreated can cause major quality-of-life problems, lead to loss of independence and even result in death in rare cases. Institutionalization can occur when epilepsy goes undiagnosed and the resultant confusion or dementia leads to nursing home placement, said Patricia H. Price, coordinator of the Epilepsy Program at the Centers for Disease Control and Prevention (CDC). Misdiagnosis of these patients is especially unfortunate, she said, because "if they were treated, they might be able to live on their own."
OVER A HALF-MILLION
Nationwide, an estimated 570,000 adults 65 and older are among the 2.7 million people in the United States diagnosed with epilepsy, estimated Charles E. Begley and colleagues in the journal Epilepsia (August 1999). The overall cost of epilepsy, they found, is $15.5 billion a year in healthcare and economic losses related to employment, wages and productivity.
"That is a considerable change from the past, when most doctors thought of epilepsy as a childhood problem that you may or may not outgrow," explained Steven C. Schachter, a Harvard Medical School professor and neurologist at the Comprehensive Epilepsy Center of the Beth Israel Deaconess Medical Center. One estimate showed that by the year 2020, half of patients with epilepsy will be age 65 or older, he said.
Scientists are still trying to find out why the incidence of new-onset epilepsy has significantly increased among older people since the 19805, said Tess Sierzant, a neuroscience nurse with the HealthEast Care System at St. Joseph's Hospital, St. Paul, Minn. One reason, she explained, is the growth in the number of older adults and associated risk factors, such as stroke and falls, which are more common in older people and elevate the risk for seizures. Sierzant expects the number to rise considerably as "the bubble of the baby boomers" ages. Another factor may be that increased awareness has led to better recognition.
Most people believe epilepsy always causes dramatic convulsions or leads to something very traumatic. Schachter noted, "Ninety percent of the time seizures are presented that way on television." Actually, the symptoms of epilepsy-strange feelings, memory blanks, subtle behavioral changes, an unaccountable loss of time, staring, temporary confusion or seizures-might be milder in older individuals than younger adults. Epilepsy among elders is often mistaken for another condition, such as dementia, stroke, heart disease and transient amnesia, or dismissed as a component of aging, Schachter said.
NOT ONE DISEASE
Epilepsy is a neurological disorder producing recurrent, brief electrical changes in brain cells. A seizure results from this excessive surge of electrical activity in the brain, and it can temporarily change how the person feels, senses or behaves. The condition is not a single disease, but rather a family of more than 40 syndromes. Different types of epilepsy stem from the specific part of the brain that is affected by the electrical disturbances. …