seizure in older adults

Overview

A seizure is a sudden burst of uncontrolled electrical activity in the brain. It can cause changes in movement, behavior, or awareness. In older adults, seizures often look different from the dramatic shaking you might imagine, and they can be a sign of an underlying health issue.

Seizures become more common after age 60, though they are still not a part of normal aging. They are the third most common brain-related condition in older adults, after stroke and dementia.

Seizures can affect anyone, but they are more likely in older adults who have had a stroke, head injury, brain infection, or conditions that disturb the body's salt or sugar levels. They also affect people with dementia or who take certain medications.

Symptoms

Common symptoms

• Shaking or jerking of the arms or legs
• Staring blankly and not responding
• Confusion or memory lapses
• Loss of awareness or consciousness
• Muscle stiffness or twitching
• Unusual sensations like tingling, odd smells, or a rising feeling in the stomach

Symptoms in children

• In children, seizures often involve fever (febrile seizures), shaking, or stiffening of the body.
• Children may have brief spells of staring, unusual body movements, or loss of awareness.
• Children can also have seizures that stop on their own quickly.

Symptoms in older adults

• Sudden confusion or disorientation
• Falling down without a clear reason
• Staring spells that family or caregivers may mistake for 'daydreaming'
• Brief unresponsiveness or odd movements like lip-smacking or fumbling
• Memory gaps or feeling 'foggy' after an episode
• Unusual sensations, such as sudden fear or a strange taste

Causes

Main causes

• Stroke, which is one of the most common causes in older adults
• Head injury, even a mild one from a fall
• Infection of the brain, such as meningitis or encephalitis
• Metabolic changes, like very low blood sugar or low sodium levels
• Brain tumors or other structural problems
• Dementia or other progressive brain conditions
• Sudden stopping of alcohol or certain medicines
• Sometimes no cause can be found

Risk factors

• Age over 60
• A previous stroke or heart disease
• History of head injury, especially repeated injuries
• Diabetes, particularly with episodes of low blood sugar
• Chronic kidney or liver disease
• Use of certain medications that lower the seizure threshold
• Heavy alcohol use or withdrawal

When to see a doctor

See a doctor urgently if:

• After any first seizure, seek emergency medical care immediately, even if it was brief.
• If a seizure lasts more than 5 minutes or is followed by a second seizure, call your local emergency number.
• If you have a seizure and also have diabetes, are pregnant, or have a fever, go to the emergency room right away.

Book a routine appointment if:

• If you have repeated episodes of confusion, staring, or unusual memory lapses that concern you or your family.
• If you are diagnosed with a seizure condition and need regular follow-up with a neurologist (brain specialist).
• If you experience side effects from any treatment that affect your daily life.

Diagnosis

Your doctor will start by talking with you and any family or caregiver who saw the event. Because seizures can look different in older adults, you may be asked to describe exactly what happened before, during, and after the episode. Your medical history, medications, and any recent illnesses or falls will all be reviewed.

Tests that may be done

• Blood tests to check blood sugar, salt levels, and signs of infection or organ problems
• Electroencephalogram (EEG) to record the brain's electrical activity
• Brain imaging, such as CT or MRI, to look for stroke, bleeding, tumors, or other structural changes
• Electrocardiogram (ECG) to rule out heart rhythm problems that can cause seizure-like fainting

What to expect at your appointment

The diagnostic process is usually done in a clinic or hospital and is painless. You may be referred to a neurologist, a doctor who specialises in brain and nerve conditions. Some tests may need to be repeated a few days or weeks later. It can take time to reach a clear diagnosis, but you will be guided through every step.

Treatment

Treatment for seizures in older adults depends on the underlying cause, your overall health, and how seizures affect you. The main goal is to stop or reduce seizures while keeping you safe and independent. In many cases, treating the cause – like correcting an electrolyte imbalance or improving stroke prevention – is enough.

Self-care at home

• Keep a seizure diary to record what you were doing, any triggers, and how long the episode lasted
• Take safety precautions at home, such as removing sharp-edged furniture and avoiding bathing alone unless someone is nearby
• Wear a medical alert bracelet that tells others you have a seizure condition
• Tell family, friends, and caregivers what to do if a seizure happens
• Get plenty of regular sleep – lack of sleep is a common trigger

Medical treatments

Medicines are the most common treatment for seizures that keep coming back. These are called anti-seizure medications. Your doctor will choose a medication based on your age, other health conditions, and the type of seizures you have. They will start with a low dose and increase it slowly, watching carefully for side effects. It is important to take the medication exactly as prescribed and never stop suddenly, as this can make seizures worse.

When is surgery considered?

Surgery is only considered in rare cases, such as when a specific, removable brain lesion is causing the seizures and medication does not work well. Any decision about brain surgery is made after a very careful evaluation by a specialist team.

Living with this condition

Living with seizures means planning ahead in a calm, practical way. Always take your medication on time, keep your follow-up appointments, and carry a written action plan that tells others what to do. Tell a trusted person about your condition so they can help in an emergency. You can still travel, work, and enjoy life – with a few sensible adjustments.

Lifestyle tips

• Try to get the same amount of sleep each night and avoid staying up very late
• Limit alcohol, and never suddenly stop drinking or using sedatives without medical advice
• Avoid known triggers like flashing lights, if that applies to you
• Manage stress with gentle activities like walking, deep breathing, or listening to music
• Ask your doctor about driving – there are specific rules about when you can drive after a seizure

Diet and exercise

A balanced diet supports your overall brain health. Try to eat regular meals to avoid drops in blood sugar. Staying active is encouraged – gentle exercise like walking, swimming with a companion, or tai chi can improve balance and wellbeing. Ask your doctor or a physiotherapist which activities are safest for you.

Mental health and emotional wellbeing

It is very normal to feel anxious, embarrassed, or low after a seizure. Many older adults worry about losing independence. Please remember that these feelings are just as important as physical symptoms. Talk honestly with your doctor about your mood, and ask about counselling or support groups if you need extra help.

Prevention

Not every seizure can be prevented, but many can. You can lower your risk by managing high blood pressure, keeping diabetes under control, staying hydrated, and avoiding falls around the home. Wearing a seatbelt and using a helmet when cycling or riding a motorcycle also protect against head injuries that can trigger seizures.

Vaccines

Certain infections can cause seizures, but vaccination decisions are personal. Talk to your doctor about whether you are up to date on vaccines that protect against infections like pneumococcal disease or influenza.

Screening programmes

There is no routine screening test for seizures in older adults. However, regular check-ups for health conditions like high blood pressure, diabetes, and heart disease can help reduce risk factors.

Complications

If left untreated

• Falls and related injuries, such as fractures, especially when a seizure causes a sudden fall
• Head injuries if you lose consciousness and hit your head
• Repeated seizures that become more frequent or longer
• Aspiration – inhaling food or saliva into the lungs during a seizure
• Memory or thinking problems if seizures are frequent and uncontrolled
• Anxiety, low mood, or social withdrawal
• Rarely, serious complications such as prolonged seizures lasting more than 30 minutes (status epilepticus) can damage the brain

Long-term outlook

The outlook for older adults with seizures is often very positive. For many, the first seizure is a one-time event, especially if a reversible cause is found. In people who do develop epilepsy, modern treatment can control seizures completely in around 7 out of 10 people. With proper medical care, a safe home environment, and a good support network, most older adults continue to live full and independent lives.

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