Epilepsy living in older adults

Overview

Epilepsy is a brain condition that causes repeated seizures. A seizure is a sudden burst of electrical activity in the brain that can affect how you move, feel, or behave. In older adults, epilepsy often develops after a stroke, head injury, or other brain condition, but sometimes the cause is unknown.

Epilepsy is more common in older adults than many people think. The risk of developing epilepsy increases with age, especially after 65.

Epilepsy can affect anyone, but it is especially common in people over 65. It often occurs after a stroke, head injury, or brain infection. It can also be linked to dementia or other age-related brain changes.

Symptoms

Common symptoms

• Sudden confusion or staring spells
• Uncontrollable jerking movements (convulsions)
• Loss of awareness or consciousness
• Strange sensations (like tingling, smells, or déjà vu) before a seizure

Symptoms in children

• In children, seizures may look like brief staring, sudden falls, or unusual movements. This article focuses on older adults.

Symptoms in older adults

• Brief confusion or memory lapses that may be mistaken for dementia
• Unexplained falls or loss of balance
• Blank spells or staring episodes
• Feeling suddenly confused or disoriented

Causes

Main causes

• Stroke is the most common cause of epilepsy in older adults
• Head injury (even from a fall years before)
• Brain infections like meningitis or encephalitis
• Brain tumors (both non-cancerous and cancerous)
• Dementia or other neurodegenerative conditions
• Sometimes the cause is unknown (idiopathic)

Risk factors

• Advancing age (especially over 65)
• History of stroke
• High blood pressure or diabetes (increases stroke risk)
• Head injury (from falls or accidents)
• Family history of epilepsy
• Certain brain conditions like Alzheimer's disease

When to see a doctor

See a doctor urgently if:

• If you have a seizure for the first time
• If you have a seizure that lasts more than 5 minutes
• If you are injured during a seizure
• If you have trouble breathing or consciousness does not return promptly after a seizure

Book a routine appointment if:

• You have been diagnosed with epilepsy and want to review your treatment plan
• You experience new or different symptoms that might be seizures
• You have concerns about medication side effects

Diagnosis

Diagnosing epilepsy in older adults involves a careful review of your symptoms and medical history, especially any strokes, falls, or head injuries. Your doctor will want to hear from someone who witnessed the seizure if possible.

Tests that may be done

• Electroencephalogram (EEG) – a painless test that records brain activity
• Brain imaging (MRI or CT scan) to look for stroke, tumor, or other causes
• Blood tests to check for infections or other medical conditions
• Sometimes an overnight EEG or video monitoring is done to capture a seizure

What to expect at your appointment

Your doctor will take time to understand your experiences. You may be referred to a neurologist (a brain specialist). Testing is usually not painful. It may take several visits to confirm the diagnosis and start treatment.

Treatment

The goal of treatment is to prevent seizures with the fewest side effects. Most people with epilepsy take daily medication to control seizures. Your healthcare provider will work with you to find the best approach.

Self-care at home

• Keep a seizure diary – note when seizures happen, what you were doing, and how you felt before
• Take medications exactly as prescribed – do not skip doses
• Get enough sleep – lack of sleep can trigger seizures
• Avoid alcohol or limit to very small amounts – alcohol can affect seizure control and interact with medication
• Wear a medical alert bracelet or carry an ID card indicating you have epilepsy

Medical treatments

Treatment usually starts with anti-epileptic medicines (AEDs). These drugs help prevent seizures by calming overactive brain signals. Your doctor will choose a medicine based on your seizure type, other health conditions, and potential side effects. It may take time to find the right drug and dose. Some people may need more than one medicine. Do not stop or change your medicine without talking to your doctor.

When is surgery considered?

If medicines do not control seizures, surgery to remove the small part of the brain causing seizures may be an option. This is only considered after detailed testing shows that the seizure focus can be safely removed. Other options include vagus nerve stimulation or special diets, but these are less common in older adults.

Living with this condition

Living with epilepsy as an older adult means taking steps to stay safe and well. Many people with epilepsy drive, but you must follow local laws. In the UK, you must be seizure-free for at least one year (or have only sleep seizures for three years) to drive. You can work, travel, enjoy hobbies, and socialize with good seizure control.

Lifestyle tips

• Have a regular sleep schedule – go to bed and wake up at similar times every day
• Manage stress with relaxation techniques like deep breathing or gentle exercise
• Avoid triggers like flashing lights (if you have photosensitive epilepsy) or extreme tiredness
• Plan ahead – let family and friends know what to do if you have a seizure

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and whole grains. Stay hydrated. Regular, gentle exercise like walking or swimming can improve overall health. Always check with your doctor before starting a new exercise program. Avoid activities that could be dangerous if a seizure occurred, such as swimming alone or using heavy machinery without supervision.

Mental health and emotional wellbeing

Having epilepsy can cause anxiety, depression, or stress. It is normal to feel worried about seizures. Talk to your doctor if you feel down or anxious. Support groups and counselling can help. You are not alone – many older adults live well with epilepsy.

Prevention

Epilepsy itself cannot always be prevented, but you can reduce your risk by preventing conditions that lead to epilepsy. For example, controlling high blood pressure and diabetes reduces the chance of stroke, which is a common cause. Preventing head injuries by using seatbelts, wearing a helmet when cycling, and making your home safe to prevent falls can also help.

Vaccines

There are no vaccines to prevent epilepsy. However, staying up to date with other vaccines (like the flu shot) can help prevent infections that might affect the brain.

Screening programmes

There is no routine screening for epilepsy in older adults. If you notice unusual spells, confusion, or falls, see your doctor.

Complications

If left untreated

• Repeated seizures can cause injury from falls
• Memory problems or confusion between seizures
• Loss of independence if seizures are not controlled
• Rarely, prolonged seizures (status epilepticus) can be life-threatening

Long-term outlook

With proper diagnosis and treatment, most older adults with epilepsy achieve good seizure control and can maintain an active, independent life. It may take time to find the right treatment, but many people live seizure-free for years. Talk openly with your healthcare team – they are there to help you live well.

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