Among the most prevalent disorders affecting the neurological system in the elder persons, epilepsy ranks 2nd only to stroke and demnetia. Old age epilepsy, which begins before the age of 60 and continues into old age, and new-onset epilepsy in the elderly are both included in geriatric epilepsy. Older adults’ quality of life is greatly diminished and societal health care resource burden is amplified by epilepsy, particularly late-onset epilepsy.The risk of acquiring epilepsy and seizures is highest among the elderly. Seizures and epilepsy are more common in those aged 60 and up compared to younger age groups. An estimated 85 per 100,000 for those aged 65–69, 159 per 100,000 for those aged 80 and more, and 80.8 per 100,000 for all age groups is the yearly incidence.According to a recent epidemiological study, there is an average of 240 cases of epilepsy per 100,000 people aged 65 and up per year. It is in the elderly that about 25% of cases of new-onset epilepsy develop. By 2020, half of all persons with new-onset epilepsy will be old, according to some researchers. (Lü et al., 2016)
Epilepsy and Seizures in Untreated Alzheimer’s Disease
Clinical seizures will emerge in a small percentage of AD patients over the course of the disease, but this has been known for decades. Between 1.5% and 64.0% of AD patients experienced an unprovoked seizure, according to both prospective and retrospective investigations [7–19]. The proportions tend to be lower, according to more recent, bigger, prospective research. There was a greater incidence of first seizure among individuals with clinically diagnosed Alzheimer’s disease compared to nondemented patients, with an odds ratio of approximately 6, in a study that examined all patients over the age of 55 in Rochester, Minnesota, who had their first unprovoked seizure between 1955 and 1984.
Seizures and epilepsy in families with AD
After taking disease duration and severity into consideration, it is unclear if the prevalence of seizures is higher in family instances compared to random cases, and not all affected individuals appear to have seizures. In a study including familial AD caused by presenilin-2 mutations, 30% of patients experienced seizures.Amyloid precursor protein (APP) duplications are associated with an increased risk of seizures; in fact, 57 percent of those affected in one research including five families had seizures.
Emergence of epilepsy in the elderly due to acquired factors
- Among the many known causes of new-onset epilepsy in the elders, 30%-50% can be attributed to cerebrovascular disorders such as stroke.; Typically, epilepsy can happen either before or after a stroke, or it might be a first sign of a cerebrovascular disease.
- Rather of coming from totally infarcted areas, multiple investigations have shown that partial destruction is more common as a genesis for seizures. Epilepsy risk factors include hemorrhagic transformation of ischemic stroke, which may be associated with breakdown of the blood-brain barrier.( Lü et al., 2016)
- Epilepsy can be caused by a variety of circulatory system illnesses, including huge vessel diseases, microvascular diseases, and small vessel diseases of the central nervous system. Even in the absence of stroke, radiographic evidence confirms that risk factors of cerebrovascular diseases—including hypertension, dyslipidemia, coronary and peripheral artery disease—are linked to epilepsy.
Brain Activity and Epilepsy
Epileptiform surface Seizures and other EEG abnormalities in Alzheimer’s disease patients, are rare. Few AD seizure observational studies provided EEG results, and many patients were not tested . In these trials, some seizure patients and those without seizures had epileptiform discharges. Few research have explored epileptiform discharges in AD/dementia patients. examined 1674 memory problems clinic patients’ regular EEGs. Epileptiform discharges (spikes or sharp waves) were identified in 3%, 26% of whom had epilepsy. Most discharges were focused and temporal. On discharge, 25% of patients had no clinical indication of epilepsy. Follow-up seizures were documented in two (17%) of this small sample. In another study, severe AD patients and ApoE4-positive relatives had elevated theta and delta activity and strong waves on their EEGs . The incidence and localization of epileptiform anomalies were not reported, and the authors did not provide examples. Epileptiform discharges are rare in AD and memory clinic patients, even in those with seizures, which may be because elderly people are less likely to exhibit interictal discharges on normal EEGs . Only 36% of new-onset epilepsy patients in an elderly cohort had such discharges .
Generalized convulsions
SE is a neurological emergency characterized by seizures characterized by convulsions without full awareness recovery lasting more than 10 minutes. In practical practice, elderly SE is prevalent. In a retrospective analysis, 7.5% of 60-year-olds had SE.69 Drug use is often linked to SE. SE can develop in 15% of drug-induced seizures, especially with antibiotics.( Friedman et al., 2011)
Penicillins, cephalosporins, carbapenems, and quinolones can cause SE, especially when given intravenously in individuals with liver or kidney disease at high doses. Inhibitors of benzodiazepine and gamma-aminobutyric acid receptors include quinolones and beta-lactam antibiotics, respectively cause epileptogenesis from N-methyl-D-aspartate Cephalosporins including ceftriaxone, ceftazidime, cefotaxime, and cefepime can cause SE. Ipenem causes more seizures than meropenem. SE has been recorded with ciprofloxacin, ofloxacin, and gatifloxacin.
In renally impaired patients, prevent seizures when used with the appropriate dosage of an antibiotic with a low epileptogenic potential. Patients at risk of seizures due to central nervous system lesions and renal or hepatic impairment may benefit from aminoglycosides, azithromycin, vancomycin, clindamycin, or teicoplanin, since these medications have no SE reports.
Refrence:
Lü, Y., Liu, S., & Yu, W. (2016). The causes of new-onset epilepsy and seizures in the elderly. Neuropsychiatric Disease and Treatment, 12, 1425.
Friedman, D., Honig, L. S., & Scarmeas, N. (2011). Seizures and Epilepsy in Alzheimer’s Disease. CNS Neuroscience & Therapeutics, 18(4), 285–294.
