At least two unprovoked seizures >24 hours apart

One unprovoked or reflex seizure and a probability of having another seizure similar to the general recurrence risk after two unprovoked seizures (≥60%) over the next 10 years
An epilepsy syndrome

Causes and Clinical Presentation of Epilepsy in Older Adults2

Cerebrovascular Disease: Stroke is the leading cause of epilepsy in people >65 years, accounting for 50-75% of cases with an identifiable cause
Neurodegenerative Disorders: Patients with Alzheimer’s are ten times more likely to develop epilepsy
Trauma: Older age is an important risk factor for posttraumatic epilepsy. Head injury, mostly from falls, causes up to 20% of epilepsy in older adults
Unknown: The underlying cause of epilepsy cannot be identified in up to 50% of older adults

Clinical Presentation
  • Can be more difficult to recognize than in younger patients due to atypical presentation, differential diagnoses, and higher prevalence of comorbidities
  • Complex partial (focal) seizures are the most common presentation
  • Seizures in older adults may be more subtle than in younger people
    • May present as altered mental status, periods of staring, unresponsiveness, brief loss of consciousness, inattention, memory lapses or confusion
  • Postictal confusion tends to be prolonged, lasting for hours to days

Therapeutic Management

The overall goals of epilepsy treatment are to3:
  • Achieve and maintain seizure freedom without detrimental side effects
  • Maintain a normal lifestyle, with unchanged or improved quality of life and functional status

Response Rates

Challenge to Achieving Seizure Control

Adverse events 
ASM side effects can include memory impairment, declining cognition, dizziness, and hyponatremia. These side effects can impact adherence, contribute to declining cognition and falls, and increase hospitalization7
Drug interactions can present increased challenges when treating epilepsy in older adults 
The rate of older patients being hospitalized due to adverse drug reactions ranges from 6% up to 30%8
Comorbidities can complicate treatment decisions2
ASM side effects may aggravate pre-existing disorders, such as dementia, cardiac arrhythmias, polyneuropathy, and osteoporosis9
Hyponatremia can develop from a variety of causes, which can include some ASMs. Symptoms include weakness, dizziness, decrease of consciousness, and convulsion10 
Hyponatremia may be present in 15-18% of patients in chronic care facilities9
Hospitalization is a major driver of costs and can affect reimbursement 
Epilepsy-associated hospitalizations have increased 51% since 200011
Falls in older adults can be markers of poor health and declining function, and are often associated with significant morbidity and cost12 
1 in 3 adults aged 65 and older falls each year.13 Of those who fall, 20-30% suffer moderate to severe injuries14
ASM= antiseizure medication

References: 1. Fisher RS, et al. Epilepsia. 2014;55(4):475-482. 2. Johnston A, Smith PEM. Expert Rev Neurother. 2010;10(12):1899-1910. 3. Brodie MJ, Kwan P. BMJ. 2005;331:1317-1322. 4. Birnbaum AK, et al. Epilepsy Res. 2012;101(1-2):22- 27. 5. Gidal BE. Epilepsy Res. 2006;68(suppl 1):S65-S69. 6. Leppik IE, et al. Epilepsy Res. 2006;68(suppl 1):S71-S76. 7. Eddy CM, et al. Ther Adv Neurol Disord. 2011;4(6):385-407. 8. Nair NP, et al. Clin Interv Aging. 2016;11:497-505. 9. Trinka E. Acta Neurol Scand. 2003;108(suppl 180):33-36. 10. Siregar P. Acta Med Indones. 2011;43(3):158-161. 11. Acharya JN, Acharya VJ. Ann Indian Acad Neurol. 2014;17(suppl 1):S18-S26. 12. Fuller GF. Am Fam Physician. 2000;61(7):2159-2168, 2173-2174. 13. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Accessed August 28, 2022. 14. Sterling DA, et al. J Trauma. 2001;50(1):116-119.