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seizures in the elderly

Etiology: - ischemic stroke or hemorrhagic stroke (most common cause of new-onset seizures) 50% - intracranial mass lesion Clinical manifestations: - alert & oriented, but unable to recognize family or follow simple commands* - subacute decline in function, cognitive impairment - urinary incontinence, fecal incontinence* * case presentation does not specify type of seizure [8] Special laboratory: - electroecephalography Radiology: - MRI neuroimaging Management: 1) anticonvulsants often given to elderly after a 1st seizure - higher risk of recurrent seizure than in younger patients - seizure-related morbidity in the elderly [5] 2) consider drug interactions & drug adverse effects in selection of an anticonvulsant [1,3] - lamotrigine, levetiracetam & gabapentin may be better tolerated than carbamazepine [3] 3) supplement Ca+2 & vitamin D in women (bone mineral density may be reduced by anticonvulsants [4]

General

seizure; epileptic seizure geriatric disorder; disease of old age; geriatric syndrome

References

  1. Leppik IE, Bergey GK, Ramsay RE, Rowan AJ, Gidal BE, Birnbaum AK, Elliott MB. Advances in antiepileptic drug treatments. A rational basis for selecting drugs for older patients with epilepsy. Geriatrics. 2004 Dec;59(12):14-8, 22-4. Review. PMID: 15667018
  2. Leppik IE, Bergey GK, Ramsay RE, Rowan AJ, Gidal BE, Birnbaum AK, Elliott MB. Advances in antiepileptic drug treatments. A rational basis for selecting drugs for older patients with epilepsy. Geriatrics. 2004 Dec;59(12):14-8, 22-4. Review. PMID: 15667018
  3. Journal Watch 25(15):118-19, 2005 Rowan AJ, Ramsay RE, Collins JF, Pryor F, Boardman KD, Uthman BM, Spitz M, Frederick T, Towne A, Carter GS, Marks W, Felicetta J, Tomyanovich ML; VA Cooperative Study 428 Group. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005 Jun 14;64(11):1868-73. PMID: 15955935
  4. Prescriber's Letter 10(1):4 2003
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  6. Angus-Leppan H. First seizures in adults. BMJ. 2014 Apr 15;348:g2470. Review. PMID: 24736280
  7. Motika PV, Spencer DC. Treatment of Epilepsy in the Elderly. Curr Neurol Neurosci Rep. 2016 Nov;16(11):96. Review. PMID: 27628963
  8. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  9. Ip Q, Malone DC, Chong J, Harris RB, Labiner DM. An update on the prevalence and incidence of epilepsy among older adults. Epilepsy Res. 2018 Jan;139:107-112. Epub 2017 Dec 5. PMID: 29220741
  10. Sen A, Jette N, Husain M, Sander JW. Epilepsy in older people. Lancet. 2020 Feb 29;395(10225):735-748. PMID: 32113502 Review.