Title: New Onset Unprovoked Seizures in Elderly: Etiology and Challenges in Management
Authors: Dr M.Thangaraj, Dr M.Arun Kumar, Dr K.Balamurali, Dr S.Elangovan
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.216
Abstract
Contrary to popular belief the incidence of epilepsy and seizures increases in elderly people. New onset epilepsy in elderly often has underlying etiology including cerebrovascular diseases, neurodegenerative disorders, intracranial space occupying lesions and post traumatic epilepsy. An acute symptomatic seizure provoked by metabolic derangement, encephalopathy or meningitis, though commonly seen in elderly patients, can’t be termed as unprovoked seizures. Making a proper diagnosis in these patients may be difficult because many times history is not clear. Moreover elderly patients make a heterogeneous group of people. Many of them may be quite healthy while others may have chronic debilitating diseases involving nervous system like dementia, Alzheimer's and Parkinson’s disease etc. With improvement in quality of life and availability of advanced health care facilities there is a rise in life expectancy of elderly individuals. This increase in life expectancy has an effect of increase in number of elderly people which consequently means there will be increasing number of patients having newly onset epilepsy beyond the age of 60. Not only the diagnosis is challenging in these patients but also treatment is difficult. Age related physiological changes, presence of co-morbidities, financial constrains and neglect by family members are some of the practical hurdles faced by treating physician while treating these patients. Treatment needs to be carefully selected because many elderly patients are expected to be already on multiple medications due to co-morbidities. Anti-epileptic drugs in these patients needs to be chosen keeping in mind Side effects, drug interactions and tolerability of the prescribed drugs We conducted a prospective study comprising of patients who had first episode of unprovoked seizures at or above the age of 60 years. The seizure characteristics, etiology, radiological abnormalities and response to treatment in these patients were studied in detail.
Keywords: Unprovoked Seizures, elderly, co-morbid conditions, anti-epileptic drugs.
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