Home |  Elder Rights |  Health |  Pension Watch |  Rural Aging |  Armed Conflict |  Aging Watch at the UN  

Mission  |  Contact Us  |  Internships  |  Donate Now!  

back

WASHINGTON (AP) -- 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 convulsive 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.

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.

Seniors are particularly prone to feeling drained, forgetful or confused after seizures, sometimes for days.

Proper treatment can be hard to get, too. Older patients need far lower doses of epilepsy medicine than younger people, as metabolism and kidney function decline with age.

Seniors often take lots of drugs for other conditions, so toxicity-causing drug interactions complicate prescribing.

Worse, some of the most-prescribed treatments can drastically impair memory and mood, especially in higher doses. Many primary care doctors don't know about senior doses and dismiss drug side effects as simply getting old, laments Devinsky, author of an epilepsy patient guide.

He recalls a 74-year-old patient with a disabling tremor he feared was Parkinson's disease, plus such fatigue and depression that he ignored even his grandchildren. The culprit: Another doctor had prescribed a dose of Depakote appropriate for a 20-year-old. Devinsky switched to a low dose of another drug, Lamictal, that controlled his epilepsy just as well -- but the tremors and depression disappeared and the man's a doting granddad again.

Devinsky calls phenobarbitol the worst therapy for seniors. This very old drug is widely used because it's cheap but it can cause severe cognitive side effects.

Seniors' best therapy, however, is debatable. Devinsky says Lamictal, Neurontin and Keppra seem least likely to cause cognitive problems. Barkley, an Epilepsy Foundation adviser, calls carbamazepine an equally good but cheaper choice. Rowan's study could offer guidance -- it compares Neurontin, Lamictal and carbamazepine. Results are due next year.

Meanwhile, what should seniors know?

--Clues to subtle seizures are brief but repetitive spells characterized by any of the following: a dreamy state, a funny rising sensation in the stomach, a strange sense of taste or smell, a sense of deja vu, dizziness or ringing in the ears. You may feel drained afterward. Relatives may describe brief staring episodes.

--Describe those sensations precisely, says Devinsky -- nausea isn't the same as a welling up in the stomach. Don't hesitate to say, ``I might be having seizures'' to ensure that's considered.

--If you don't have seizure control in six to 12 months, see an epilepsy specialist, says Barkley.

FAIR USE NOTICE: This page contains copyrighted material the use of which has not been specifically authorized by the copyright owner. Global Action on Aging distributes this material without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes. We believe this constitutes a fair use of any such copyrighted material as provided for in 17 U.S.C § 107. If you wish to use copyrighted material from this site for purposes of your own that go beyond fair use, you must obtain permission from the copyright owner.