Epilepsy often poorly treated in seniors

Tuesday, March 26, 2002

WASHINGTON -- The grandfather watches TV when suddenly he feels a funny rising sensation in his stomach, a dreamy sense of deja vu and a strange aftertaste. It lasts only about a minute.

Weird, he thinks, but shrugs it off, though he's tired and forgetful for the next few days.

Such subtle symptoms actually can be a classic sign of epilepsy in the elderly, confusing because it's not the stereotypical seizure.

Commonly considered a childhood disorder, in fact epilepsy strikes the elderly at higher rates than other ages. And experts say misdiagnosis and faulty treatment -- because too few doctors know seniors need special doses and are prone to bad side effects -- is a serious problem poised to worsen as the population ages.

Until recently, "the elderly were neglected," says Dr. A. James Rowan of the Bronx Veterans Affairs Medical Center, who is co-directing one of the first major studies comparing epilepsy therapies for seniors. "They were treated the same as any other adult when their problems are quite different."

Epilepsy is essentially periodic electrical storms in the brain. When brain circuits misfire fast enough, a seizure results.

More than 2 million Americans have epilepsy. Some were born with it, although many diagnosed as children outgrow the disorder.

Risk increases with age

But it can strike at any age, particularly after injury to brain cells, such as head trauma, meningitis, even a mini-stroke or years of high blood pressure. Those risks increase with age. Of the 181,000 people diagnosed with epilepsy each year, 68,000 are over age 64.

"Physicians are not used to thinking about seizures in this age group," says Dr. Orrin Devinsky, director of the New York University and Mount Sinai Comprehensive Epilepy Centers, who says up to half his patients were misdiagnosed at some point.

Seizures aren't confined to convulsions and fainting. First ones especially can be much more subtle, such as a brief glassy-eyed stare or vague sensations like the stomach complaint so common in elderly patients. So often, "the last thing people think about is a seizure," Devinsky says.

Another peculiarity of aging further hinders diagnosis. Brain scans hunt for a spiking wave common in children but far less likely in an older brain, says Dr. Gregory L. Barkley of the Henry Ford Comprehensive Epilepsy Program in Detroit.

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