Epilepsy Support Group

Sunday, May 31st

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Epilepsy in Senior Citizens

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Though most of the epilepsies occur in infancy or childhood, some seizures begin late in life and the incidence of seizures which ids low in the 20-50 gage groups again starts increasing after 60 yrs.

Epilepsies in the elderly may be primary (i.e. without any cause being found), or secondary to lack of blood supply, or trauma, or tumors, to name a few common causes. In view of these, all seizures beginning late in life need to be thoroughly investigated.

One needs to be careful in treating elderly patients. They often have multiple other illnesses, e.g. high BP, diabetes, heart disease, stroke, arthritis etc. The medicines we give should not worsen any of these conditions. More importantly they should not interfere with the medicines which the patient is already taking. Hence it is important that the patient reveal his medicines in detail during the initial visit to a specialist. Often patients are taking medicines for sleep, chakkar, acidity, weakness or other common ailments which they fail to inform the neurologist and this may sometimes lead to drug interactions which may reduce the effects of medicines for seizures.

Secondly, elderly people tolerate drugs very poorly and are more prone to "Side effects" (these are in fact over effects and can be easily remedied). The dose needed by these people is often only ½ or 2/3 the usual dose. Hence we often start with very small doses and increase these gradually, depending on how the patient tolerates the medicine. The choice of drug is often dictated by how safe it is rather than how effective it is.

one needs to watch carefully for the side effects especially chakkar, imbalance, sleep disturbances, as falls in the elderly often lead to fractures and can be quite disabling.

Also close watch on medicines and side effects has to be kept during other illnesses which may be unrelated to the epilepsy, especially during fevers, or during any operations the patient may be undergoing.

Once epilepsy develops in late life, it most often needs lifelong medication, and patients need to be counseled regarding this and should be mentally prepared. In our society, patients are reluctant to take long term medicines, and this is especially true in case of the elderly, and more so for allopathic medicines and hence more counseling and reinforcement id as well as encouragement is needed at every follow up.

Thus epilepsy in the elderly needs a different approach as compared to the children. These patients need to actively participate in their treatment and psychological handling is needed as much as medical management.

Contributed by
Dr. Hemant Sant
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