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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
- 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
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
Challenge to Achieving Seizure Control
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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.