Healthy Edge
Late-Life Epilepsy: It's Not What You Think
Imagine you're visiting a good friend. He's so outgoing and energetic, and best of all, he loves it when you pop by. Today, he seems uncharacteristically out of sorts. He's confused. Tired. Having difficulty talking. You're concerned. Did he have a stroke? Is he having a drug reaction? What if he's developed Alzheimer's?
Your friend may have epilepsy. Roughly 1-2 percent of Seniors develop epilepsy - and that rate is rising.
The above scenario probably doesn't fit your picture of epilepsy. If asked to visualize epilepsy, you likely see a child, unconscious and convulsing. [In the case of Jett Travolta (John Travolta and Kelly Preston's son), a falling accident caused by an uncontrolled seizure led to his untimely and tragic death.]
Yet, children account for only 13 percent of all people with epilepsy.
Surprisingly, epilepsy affects Seniors more than any age group. In the state of Florida, where there are 360,000 people with diagnosed epilepsy, approximately one in four is a Senior.
Is this news to you? It was to me. So, I interviewed Dr. Mark Spitz, the director of the Comprehensive Epilepsy Center at the University of Colorado Health Sciences Center ,to learn why.
It's probably because most Seniors with epilepsy have relatively subtle seizures called complex partial seizures, said Dr. Spitz. Seniors don't typically suffer from tonic-clonic seizures (previously called "gran mal" seizures). Those are more common amongst children with epilepsy.
Dr. Spitz explained that to an observer, a complex partial seizure may appear as a brief staring spell or the sudden onset of confusion. It's closely followed by a long (up to 24 hour) recovery period. Because the seizure itself is so brief, the sufferer's loved ones seldom witness it; they tend to witness the post-ictal (post-seizure) stage, marked by fatigue and "an unexplained, abrupt deterioration in cognitive abilities." In children, recovery lasts only minutes to hours.
Dr. Spitz and Jim Lyons, Executive Director of the Florida Epilepsy Foundation at the Gainesville Florida site, shared other Senior-related epilepsy realities that often get lost in epilepsy discussions. Their insights may help you or your loved ones prevent or manage late-life epilepsy.
PREVENT IT?
Perhaps the most common cause of epilepsy in Seniors is atherosclerosis - the hardening of arteries that leads to strokes and transient ischemic attacks. Seniors with pre-existing cardiovascular disease, especially those who have suffered a stroke, have an increased risk for developing epilepsy. Dr. Spitz says that's why more Seniors are developing epilepsy.
Recommendation: Start walking, spend time with friends, eat a healthy diet and get that hypertension under control - lowering your cardiovascular disease risk may lower your epilepsy risk. Whether you have hypertension or not, you may want to revisit that DASH diet article I wrote last January!
SUSPECT IT? GET MEDICAL HELP-FAST!
A multi-center study Dr. Spitz performed in 2003 with the Veteran's Affairs Cooperative showed a shocking delay in the diagnosis of Seniors with epilepsy. On average, a Senior's diagnosis takes a year and a half. Worse yet, the average Senior doesn't seek medical attention until 9 months after the first seizure. Even your physician can be fooled by late-life seizures. Senior epilepsy is often misdiagnosed as transient ischemic attacks.
Recommendation: Use these two tips to shorten your diagnosis time.
1. Even before you visit your doctor, call the Gainesville office of the Epilepsy Foundation of Florida at 352-378-4324. Regardless of your financial situation, their referral, medical, informational and emotional support services run the gamut.
2. When you go to your appointment, bring a spouse or friend who can describe your seizures and recoveries.
3. CONTROL IT!
Good news! Seizure control in Seniors tends to be faster than that of other age groups and requires lower dosages. The initial anti-epileptic drug (AED) prescribed usually works. And, if you're seizure-free for a year or two, your doctor will likely withdraw your medication.
But, Seniors are also more sensitive to AED side effects such as sedation, confusion and balance problems. When Dr. Spitz's patients say, "Doc, I'm on too many meds," he knows it's time to make adjustments.
Seniors are also more likely to experience a drug-drug interaction because they rely on meds for other conditions. For example, some older AEDs reduce the efficacy of Simvastatin (Zocor(r)), a cholesterol controller.
Recommendation: Let your doctor know that unless there's a reason not to, you would prefer a newer AED as your initial therapy. According to the American Academy of Neurology treatment guidelines, newer AEDs are less likely to cause intolerable side effects and interactions, and they are just as effective as the older AEDs.
After you control your epilepsy, it won't control you. For example, those with controlled epilepsy can resume driving. In Florida, applicants and licensed drivers who are seizure-free for two years are eligible for a license. Seniors under regular medical supervision can apply for a review by the Medical Review Board after being seizure-free for as little as six months.
For more information about any aspect of epilepsy, contact the Epilepsy Foundation of Florida 352-378-4324. Their office is located at 1000 NW 8th Avenue in Gainesville.
The Epilepsy Foundation of Florida "works to ensure that people with seizures are able to participate in all life experiences; improves how people with epilepsy are perceived, accepted and valued in society; and provides medical care, prevention and education, case management, support groups, children's camps and advocacy for persons with epilepsy."
Kendra Siler-Marsiglio, Ph.D. is the Director of the Rural Health Partnership at WellFlorida Council.
