When an elderly person becomes confused, forgetful or dizzy, most loved-ones want to look past it, assuming the momentary pause is a natural part of aging. But these episodes may be caused by a disease that is more commonly associated with younger adults: epilepsy.

As epilepsy is diagnosed in more and more seniors in the United States, there is a growing understanding of how this disease affects the elderly differently than it does teens. Dr. Joseph Sirven, associate professor of neurology at the Mayo Clinic College of Medicine in Scottsdale, Arizona explains why epilepsy is a relatively common problem for aging adults and why diagnosis and treatment is so important.

How common is epilepsy in the elderly?

It's very common. There are anywhere between 80 to 123 cases for every 100,000 people in the population. To give you some context, Alzheimer's disease affects about 102 individuals for every 100,000 people. So, the numbers we're talking about are fairly high. Epilepsy is one of the more common things that is seen in older adults from a neurological perspective.

Why would somebody start to get epilepsy as they get older?

It's a phenomenon that often occurs along with other things that happen as you get older. It is sort of a side-effect of many things that we are more likely to get as we age. For example, stroke is one of the biggest causes of seizures in older adults. Twelve percent of patients with dementia of any type will have seizures, and dementia is very common in older adults. Also, tumors and trauma can cause seizures.

We don't know what it is about the aging brain that lets this happen, but clearly there is something that occurs that makes epilepsy a stronger likelihood.

Are more seniors getting epilepsy?

They may be. There are more cases of epilepsy in the elderly population, but we don't know if it's truly an increasing number of cases or if it's just that we are now looking for it and are able to better detect it. It could very well be that we just recently opened up our eyes, and we finally now see that epilepsy is affecting more adults that previously thought.

Does epilepsy often go unnoticed in the elderly?

I don't know if it's disregarded, but it's just not appreciated in the sense that a seizure in older adults looks so much like so many other things. People don't think of it as one of the possibilities.

What are the symptoms that indicate that someone is experiencing a seizure?

If someone is having repeated episodes of loss of consciousness, dizziness, language or behavioral change then they should really be considering the possibility that they are experiencing epilepsy.

What are some of the things that a seizure may be confused with?

It can look like dizziness. It can look like a sensory change or numbness. It can even look like a tremor. And even in the dramatic ones where there is a change in the level of consciousness and the person is just not acting like oneself, it can often be ascribed to other conditions like "Oh, this person might have dementia" or "He might have an infection." And you just don't think of a seizure in those instances.
Are there any added dangers when a seizure occurs in an older person?
There is more detriment to an elderly person who has a seizure because seizures can lead to falls, and falls are well documented to lead to broken hips, and a broken hip is the number one reason for someone to be admitted to a nursing home.

Also, it takes longer for the elderly to recover from a seizure and, thirdly, these patients don't have the same amount of cognitive [mental] reserve to begin with as a younger person.

How does a doctor make a diagnosis of epilepsy?

Basically, a doctor would have to first get the history of the patient and hear that they are having some sort of spells. Then, the testing typically will consist of something like an electroencephalogram (EEG), in some cases an MRI.

Is treatment for epilepsy in the elderly different than it would be for someone younger?
Treatment tends to consist of the same medications, but they are given at a lower dose and at a slower pace. A doctor would slowly ramp up those medicines to be sure they are not causing adverse effects in the patients.

Are there any added concerns when treating the elderly?
One of the biggest issues is that there are many drugs that interact with seizure medications. Older patients can take anywhere from seven to 13 medications at one time. When choosing a drug to treat epilepsy, a doctor has to be sure that he picks things that are not going to interact or going to cause more adverse effects.

What are the long-term consequences of epilepsy?
The long-term problem of seizures is that, if you don't get them controlled, it's going to lead to problems with your memory and cognition over time. Once it's controlled, you can at least slow that type of thing down.

What advice do you have for someone who notices these changes in a loved-one?
Well, the main problem is that if you don't think about epilepsy, you'll never find it. So people should always be considering it.