Seizures in the Older Adult: Misdiagnosis Leads to Consequences

Abstract

In the USA, it is estimated that the percentage of citizens aged 65 years and older will rise to 21% of the population by the year 2050 [101]. The group aged 65–84 years is expected to grow over 100% and the group aged 85 years and older will grow almost 400% [101]. These increases dwarf the increases of all other age groups of Americans and similar increases are projected in many other countries. Due to the increase in the number of older adults, there is a greater need for attention to geriatric healthcare. An increase in the number and instances of age-related disorders is predicted. Some of the more common yet unrecognized problems are seizures and epilepsy (the condition of repeated seizures), which are more frequent in older adults than in any other age group. Indeed, after dementia and stroke, seizures and epilepsy are the third most common neurological disorders afflicting older adults [1,101,102]. Approximately 30% of new cases of epilepsy occur in individuals over the age of 65 years [1,101,102]. The incidence of seizures rises for each decade after 60 years, peaking at the age of 80 years and older [1,101,102]. Seizures are an abnormal electrical discharge of the brain and are categorized into two main types: partial and generalized. Partial seizures are defined as episodes in which there is an abnormal electrical discharge of a localized area of the brain, as opposed to a generalized seizure, which suggests bilateral cortical involvement with the electrical discharges. Partial seizures are the most common seizure type noted in older adults. Approximately 50% of seizures in the older adult are of complex partial type. This is followed by simple partial seizures, which account for 20%, and these are defined as seizures that have no impairment of consciousness [1,101,102]. Another 20% have a generalized tonic–clonic seizure, otherwise known as convulsions or grand mal seizures [1,101,102].