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