9Th Annual Teleconsults in Epilepsy Sirven

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Funny Spells: Recognizing and Diagnosing Seizures in the Elderly: 

Funny Spells: Recognizing and Diagnosing Seizures in the Elderly Teleconsults in Epilepsy Series IX Joseph Sirven, MD Associate Professor of Neurology Mayo Clinic College of Medicine

Unique Aspects of Epilepsy in the Elderly: 

Unique Aspects of Epilepsy in the Elderly Epidemiology Etiology Unique Impact of Seizures in the Older Adult Seizure Presentation Differential Diagnosis

Epidemiology: 

Epidemiology

Epidemiology of Seizures and Epilepsy in the Elderly: 

Hauser, 1998. Epidemiology of Seizures and Epilepsy in the Elderly Elderly: numbers increasing in general population (about 30% of new cases are over age 65 years) Medical conditions affecting elderly increase risk for seizures and epilepsy Third most common neurological disorder Acute symptomatic seizures Stroke Brain tumor Head injury Dementia Toxic metabolic

Incidence of Acute Symptomatic and Unprovoked Seizures in the Elderly: 

Incidence of Acute Symptomatic and Unprovoked Seizures in the Elderly 300 250 200 150 100 50 0 0 20 40 60 80 Unprovoked† Acute Symptomatic* Age (yrs) Incidence/100,000 *Annegers JF, et al. Epilepsia. 1995;36:327-333. †Hauser WA, et al. Epilepsia. 1993;34:453-468.

Epidemiology: 

Epidemiology POINT Seizure Disorders are a significant problem in the long-term care setting

Epilepsy Etiology in People>64 Years of Age: 

Hauser WA. Epilepsia. 1992;33(suppl 4):S11. Epilepsy Etiology in People andgt;64 Years of Age

Etiology: 

Etiology POINT: Common illnesses afflicting older adults are often the precipitants of seizures and it is therefore not unexpected to see seizures in individuals with these conditions

Unique Impact of Seizures in Older Adults: 

Unique Impact of Seizures in Older Adults Postictal state is prolonged in 14% andgt; 24 hour postictal state Godfrey 1982, 1989 Todd’s paralysis more common Norris 1982 Seizures may be more injurious Falls which result from a seizure can have a devastating effect Falls may lead to functional dependence Impact ADLs Nursing home admissions Tinetti 1997

Unique Impact of Seizures in the Older Adult: 

Unique Impact of Seizures in the Older Adult Point: Identification and treatment of seizures in the elderly can significantly and positively impact QOL

Seizure Classification: 

Seizure Classification Partial Simple partial Complex partial

Seizure Presentation in Older Adults: 

Seizure Presentation in Older Adults

Seizures in Older Adults: 

Seizures in Older Adults Older patients often have more frontal and parietal lobe foci than temporal lobe foci. Auras of dizziness SPS are often more focal motor and sensory CPS present with altered mentation, staring, blackouts, confusion

66 yo male “ Feeling drugged”: 

66 yo male ' Feeling drugged'

Seizures in Older Adults: 

Seizures in Older Adults Point: Seizures are often missed or misdiagnosed

Differential Diagnosis: 

Differential Diagnosis Easily mimics Syncope TIA TGA Vertigo

Seizure Recognition: 

Seizure Recognition POINT: Episodes of Loss of Consciousness Episodes of Dizziness Episodes of Confusion Episodes of Language Change Think seizures

Questions Raised by a First Seizure: 

Questions Raised by a First Seizure Seizure or not? Focal onset? Evidence of CNS dysfunction? Metabolic precipitant? Seizure type? Syndrome type? Studies? Start AED?

Summary: 

Summary Algorithm for Diagnosing Seizures

Slide20: 


Seizure First Aid: 

Seizure First Aid

First AidTonic-Clonic Seizure: 

First Aid Tonic-Clonic Seizure Turn person on side with head inclined toward ground to keep airway clear, protect from nearby hazards Transfer to hospital needed for: Multiple seizures lasting 5 minutes or longer or status epilepticus Person is injured or diabetic New onset seizures DO NOT put rigid object in mouth or restrain

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