Epilepsy Talk

Seniors — Alzheimer’s, Epilepsy or Seizures? | March 13, 2023

The question of whether a person has epilepsy or Alzheimer’s can be a tough one.

Take those “senior moments” — memory lapses, zoning out and other temporary confusion.  These seemingly harmless incidents may actually be a sign of epilepsy.  Roughly 1-2 percent of seniors develop epilepsy — and that rate is rising.

But experts at the U.S. National Council on Aging warn that often epilepsy goes undetected in seniors.

Yet epilepsy affects some 300,000 seniors in the United States, and older adults are the fastest growing population group with epilepsy. By 75 years of age, three percent of the population will likely be diagnosed with epilepsy, 10 percent will have had a seizure of some type. In contrast, only 1 percent will have developed epilepsy by age 20.

“Epilepsy is one of the most often misdiagnosed, mistreated, or under treated conditions affecting seniors,” said James Firman, president and CEO of the council. We believe seniors, their families, and their caregivers need to be more aware of the growing prevalence of epilepsy in this age group so they can discuss telltale symptoms with their physicians.”

Alzheimer’s and epilepsy…

When people have unprovoked seizures, or seizures with no known causes, doctors diagnose epilepsy.

According to the Epilepsy Foundation, about 300,000 seniors currently suffer from epilepsy, and the number of seniors with the condition continues to grow.

Doctor’s believe that Alzheimer’s disease results from plaques in a person’s brain, although they aren’t sure what causes those plaques to develop. A number of Alzheimer’s patients also experience seizures, which may result from those same plaques.

Stroke is the most common cause of seizures in older adults, causing about 33 percent of all cases of senior epilepsy.

And seniors with pre-existing cardiovascular disease, have an increased risk for developing epilepsy.

Seniors are also at risk for dementia, including Alzheimer’s disease, which is the second most common cause of epilepsy in older adults. These degenerative diseases damage the brain and, very often, result in seizures.

And it’s also possible that epilepsy in a senior citizen marks the return of a seizure disorder that was in remission, or it may be the continuation of a life-long problem.

Seizures versus epilepsy…

While epilepsy, Alzheimer’s disease, stroke, and heart attacks remain the most common causes of seizures in the elderly, other things can cause seizures in senior citizens. Like endocrine disorders, fever, electrolyte imbalances, infections of the central nervous system (like meningitis), and brain tumors.

Arteries may become narrowed or clogged, depriving parts of the brain of blood and oxygen. The resulting damage may produce seizures.

Bleeding in the brain, which is another form of stroke, may also leave a person with seizures afterwards.

Heart attacks may temporarily cut off oxygen to the brain, causing seizures.

Complications of diseases, like liver and kidney disease, alcoholism and even diabetes may make people more likely to have seizures in later life.

Brain tumors of any kind may cause seizures. And brain diseases that change the internal structure of the brain, may cause seizures.

Scar tissue from an operation on the brain, may cause seizures later on.

Also a number of common medications can cause seizures in some patients, including antipsychotics, antidepressants, insulin, and some painkillers. Withdrawal from certain medications, such as sedatives, can also cause seizures.

Solutions?

For some unknown reason, elderly onset epilepsy is usually easier to control compared to epilepsy that begins in a younger age.

Also, some of the second-generation AEDs seem to be more easily tolerated by the elderly versus the first-generation AEDs.

So you have to ask: “If elderly patients with epilepsy tolerate some of the newer AEDs better, why do physicians continue to prescribe first-generation AEDs?”

One argument that some physicians use is that older anti-epileptic drugs are cheaper. But the patients pay a price. And recent studies suggest the use of first-generation AEDs may actually be more expensive in terms of total health care costs.

To add insult to injury, first-generation medications have strong interactions with many other medications that seniors take, which doesn’t happen with some of the new generation AEDs.  One of the major and most used drugs that has poor interactions with first-generation AEDs is statins. And how many people do you know who take statins? (I’m 67 and I take statins!)

So you can see, there’s still a lot of work to be done in the research field.  Whether it’s Alzheimer’s, epilepsy or seizures…the first step is to recognize them. And then the next step is to develop the proper protocols and medications to treat them.

For a fascinating read, click here: Epilepsy drugs as ‘chemical restraint’ on rise in nursing homes https://www.washingtonpost.com/business/2022/11/17/nursing-home-drugs-dementia/?pwapi_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWJpZCI6IjEyMjgxMzg5IiwicmVhc29uIjoiZ2lmdCIsIm5iZiI6MTY2ODc3MjYwMCwiaXNzIjoic3Vic2NyaXB0aW9ucyIsImV4cCI6MTY2OTk4MjIwMCwiaWF0IjoxNjY4NzcyNjAwLCJqdGkiOiIyYjdkMzYxYi1hMmUzLTQwZWEtOGQ1ZC03NmY0YWIxNGYzYjMiLCJ1cmwiOiJodHRwczovL3d3dy53YXNoaW5ndG9ucG9zdC5jb20vYnVzaW5lc3MvMjAyMi8xMS8xNy9udXJzaW5nLWhvbWUtZHJ1Z3MtZGVtZW50aWEvIn0.digP29MLFadEYVJlxzLqinoLs0r_40N7A-zuBVCh2qA

Resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482722/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918803/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-and-aging#causes-of-epilepsy-in-older-people

https://www.ilae.org/journals/epigraph/epigraph-vol-20-issue-2-fall-2018/alzheimer-s-and-epilepsy-intimate-connections

https://www.webmd.com/alzheimers/news/20170502/silent-seizures-tied-to-alzheimers-symptoms#1

https://www.cureepilepsy.org/event_type/aging-and-epilepsy-consequences-and-comorbidities-to-consider-in-older-individuals/

http://www.everydayhealth.com/epilepsy/understanding/epilepsys-and-older-people.aspx

https://www.uclahealth.org/departments/neurology/about-us/brains-neurology/dementia-accounts-higher-death-rate-among-people-with#:~:text=People%20with%20epilepsy%20develop%20Alzheimer’s,brain%20and%20contribute%20to%20dementia.

https://academic.oup.com/brain/article/141/6/1592/4915830

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