Complications from Epilepsy in the Elderly

The following is a literature review of the article “Epilepsy in Older Adults: Common Morbidities Influence Development, Treatment Strategies, and Expected Outcomes” by A. James Rowan, MD. The article originally appeared in Geriatrics, volume 60 issue 12, in December 2005.

Epilepsy is an extremely dehabilitating condition that commonly affects older adults. Patients exhibiting seizure disorders and their comorbidities should be referred to an epileptologist or neurologist with the primary physician remaining involved in the patient’s care. A variety of comorbidities is associated with epilepsy and influence its occurrence, effect, and treatment.

Morbidities that impair function and lead to the occurrence of epilepsy in older adults include:

• Cerebrovascular disease
• Stroke
• High blood pressure
• Brain tumors (specifically malignant glioma or metastatic)
• Alzheimer’s disease

Morbidities can also result from the occurrence of seizures in older adults. In these instances, seizures usually complicate preexisting health problems for geriatric patients, including fractures and dislocations from falls (which the elderly are more susceptible to due to osteoporosis); head injuries including concussion, headache, and intracranial bleeding; and lacerations and bruises.

These morbidities often affect the treatment of epilepsy through two primary ways. First, decreased or loss of eyesight and/or decreased fine motor movements of the hands can prevent a patient from being able to properly follow a medication regimen. Second, patients may lose the ability to concentrate or remember when they last took their medications.

Additionally, antiepileptic drugs (AEDs) have various effects on elderly patients. While some AEDs prove to be effective, others are known to cause adverse side effects including ataxia, hyponatremia, soft-tissue changes, and tremor. It is important that patients and care givers consider all alternatives and types of AEDs and discuss options in depth with their physicians and specialists.