Epilepsy Can Be Subtle for Seniors

Brief 'spaced-out' episodes may be minor seizures, experts say

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By Meryl Hyman Harris
HealthDay Reporter

FRIDAY, July 14, 2006 (HealthDay News) -- Increasingly, doctors are finding that older people whose minds seem to wander are suffering from a treatable condition -- epilepsy.

In fact, older Americans now make up the highest percentage of the 200,000 people newly diagnosed with epilepsy each year in the United States. Currently about 570,000 persons over the age of 65 have epilepsy, according to the Epilepsy Foundation.

That number may even be higher, because, unlike the dramatic convulsions usually associated with the condition, seizures in this age group can often be subtle and easily missed by patients, family members, caregivers, and even doctors.

It's not like having a "senior moment," when you are searching for a word, said Tess Sierzant, a neuroscience clinical nurse specialist at St. Joseph's Hospital HealthEast Neurovascular Institute, in St. Paul, Minn.

The type of episode most commonly seen in the elderly is put under the heading of "complex partial seizure," she said. "That can sometimes be as innocuous as someone spacing out for a brief period of time, with abnormal movements of the arms, legs, or mouth," said Sierzant. "People get up and wander and do automatic activities, but the common thread is there is an effect in the level of consciousness. In older adults it can be subtle and that is why they are often overlooked."

But if you know what to look for, you can spot the signs, said Dr. Edward Bromfield, chief of the Division of Epilepsy at Brigham and Women's Hospital in Boston and an assistant professor of neurology at Harvard Medical School.

"People blank out for a moment or two, but there may be lip-smacking, or there will be picking at things with their hands. If people are looking, they'll see. But if someone comes in at the tail end, it can be missed," he said.

Seizures are caused by electrical impulses gone awry in the brain. In older people, they are often the result of stroke that may or may not have been diagnosed. Too often people chalk up unusual behavior to the normal process of aging or dementia, doctors say.

Some people wonder if there is any point in going through a brain scan for a diagnosis, said Sierzant.

But epilepsy can greatly diminish quality of life, Bromfield said, and about 75 percent of patients can expect to derive real benefit from drugs that don't interfere with other medications an elderly person may require.

He pointed to the example of a man of retirement age who was able to continue working as a salesman because he sought help. The man had been having trouble speaking, said Bromfield. Still, he didn't tell anybody until he suffered a full-blown convulsion during the night and awoke on the floor.

"That is a fairly common occurrence. People ignore signs and then eventually one (electrical) discharge spreads enough to have a convulsion," Bromfield said.

Even then, some people are reticent to talk about seizures, in part because of old ideas about their origins and outcomes, said Dr. Brien Smith, medical director of the Comprehensive Epilepsy Program at Henry Ford Hospital in Detroit.

That may be changing, however. Older people today appear to be less reluctant to talk about epilepsy than were their parents, Smith said. And with the numbers growing yearly as the population ages, "I think there will be more understanding," he said.

If you suspect someone you know may have epilepsy, it is important to tell the doctor, said Sierzant, and it's also a good idea to seek out a specialist well-versed on the condition.

She also urged family and friends who notice symptoms to be pro-active by speaking up and clearly describing what they saw. "The patient might not remember they have these things. A description of the event is a critical piece in diagnosis," she said.

More information

For more on epilepsy, head to the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Tess Sierzant, R.N., M.S, neuroscience clinical nurse specialist, St. Joseph's Hospital HealthEast Neurovascular Institute, St. Paul, Minn.; Edward Bromfield, M.D., chief, Division of Epilepsy, Brigham and Women's Hospital, Boston, and assistant professor, neurology, Harvard Medical School, Boston; Brien Smith, M.D., medical director, Comprehensive Epilepsy Program, Henry Ford Hospital, Detroit; the Epilepsy Foundation

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