Can older adults have absence seizures? Understanding Late-Onset Epilepsy

While absence seizures are most commonly associated with childhood, epilepsy is surprisingly more common in older adults than in any other age group. These seizures can present differently in seniors, leading to underdiagnosis and delayed treatment. So, can older adults have absence seizures? Yes, although rare, it is a possibility that requires careful medical attention.

Quick Summary

It is possible for seniors to experience absence seizures, though this is considered uncommon and may be part of a broader late-onset epilepsy syndrome. Symptoms can be subtle and easily mistaken for normal aging, dementia, or other conditions, making proper diagnosis a complex process. Medical evaluation is necessary for an accurate assessment and treatment plan.

Key Points

• Absence Seizures in Seniors: Though rare, older adults can experience absence-like seizures, but they are more likely to have focal impaired awareness seizures with similar symptoms.

• Late-Onset Epilepsy is Common: Epilepsy is most common in early childhood and again in late adulthood, often caused by conditions like stroke or dementia.

• Diagnostic Challenges: Seizure symptoms in seniors are often subtle and can be easily confused with other age-related issues, leading to delayed diagnosis.

• Thorough Evaluation is Crucial: Accurate diagnosis requires a comprehensive medical history, EEG (often including sleep monitoring), and brain imaging via MRI.

• Treatment is Effective: With proper diagnosis, late-onset seizures are often well-controlled with anti-seizure medications, often at lower doses than for younger adults.

• Comorbidities Increase Risk: Underlying conditions like stroke, dementia, and brain tumors are common causes and risk factors for late-onset epilepsy.

Introduction to Late-Onset Seizures

Epilepsy, a disorder characterized by recurrent unprovoked seizures, affects millions of people worldwide, with a notable peak in incidence among older adults. While many people associate epilepsy with childhood, new-onset seizures frequently appear in seniors. For older adults, the presentation of seizures can be atypical and less dramatic than in younger individuals, often consisting of subtle changes in behavior or awareness. This makes it particularly challenging to determine if a senior is having an absence seizure, a type of generalized seizure typically seen in children.

The Likelihood of Absence Seizures in Seniors

While classic childhood absence epilepsy is highly unlikely to begin in a person's later years, the possibility of late-onset absence seizures is not zero. Older adults can experience generalized-onset seizures, and in rare cases, these can manifest as brief staring spells similar to absence seizures. For seniors, a more common scenario is a misinterpretation of focal-onset seizures, which begin in one area of the brain but may present with symptoms that resemble an absence seizure, such as a blank stare or confusion. The key distinction lies in the underlying electrical activity and the region of the brain affected. For late-onset epilepsy, cerebrovascular disease (stroke) is a leading cause, followed by neurodegenerative diseases like Alzheimer's and brain tumors.

Challenges in Diagnosing Seizures in Older Adults

The diagnostic journey for late-onset seizures can be long and challenging. This is due to several factors:

• Atypical Symptoms: Seizure symptoms in seniors are often subtle. Instead of dramatic convulsions, a senior might experience brief periods of confusion, staring spells, or episodes of unexplained memory loss. These symptoms can easily be mistaken for normal aging or other neurological conditions.
• Comorbidities: Older adults often have coexisting medical conditions, such as dementia or heart disease, which can complicate both the diagnosis and treatment of epilepsy. For example, a momentary lapse of awareness might be attributed to the progression of dementia rather than being recognized as a seizure.
• Lack of Witness: Seizures are often unwitnessed or misidentified by family members or caregivers. The brief nature of an absence seizure-like event can be easily missed or dismissed, especially if the individual has cognitive impairment.
• Differential Diagnosis: Conditions like transient ischemic attacks (TIAs), syncope (fainting), and transient global amnesia can all mimic seizure activity, requiring a thorough medical evaluation to differentiate.

Symptoms and Types of Seizures in Seniors

While typical absence seizures are rare, older adults are more likely to experience focal-onset impaired awareness seizures, which can sometimes appear similar. Here's a comparison:

Feature	Typical Absence Seizure (Childhood)	Focal Impaired Awareness Seizure (Senior)
Onset	Abrupt, with no warning (aura).	May have an aura, but often goes unnoticed.
Duration	Usually 5–15 seconds.	Often longer, 30 seconds to over a minute.
Awareness	Complete loss of awareness during the event.	Impaired or altered awareness.
Post-ictal Phase	Immediate return to normal activity.	Can involve a period of confusion, drowsiness.
Motor Symptoms	Eyelid fluttering, lip smacking, minor automatic movements.	Automatisms (lip smacking, hand fumbling), unusual sensations.
Prevalence in Age	Common in children, rare in late adulthood.	Most common seizure type in older adults.

The Importance of a Detailed Evaluation

For a proper diagnosis, medical professionals will typically perform a comprehensive evaluation. This usually involves:

1. Electroencephalogram (EEG): This test measures electrical activity in the brain. A routine EEG may miss abnormalities, so an extended ambulatory EEG that records during sleep may be necessary, as many older adults exhibit epileptiform discharges primarily during sleep.
2. Brain Imaging: A high-quality brain MRI is crucial for identifying structural causes of epilepsy, such as a stroke, tumor, or degenerative brain changes.
3. Detailed Medical History: A thorough review of the patient's and family's medical history is essential, including any medications that might lower the seizure threshold.

Management and Prognosis for Late-Onset Seizures

The good news is that with an accurate diagnosis, late-onset epilepsy in older adults is often highly responsive to anti-seizure medications. The goal of treatment is to achieve seizure control with a single agent at the lowest effective dose, minimizing potential side effects and drug interactions. Since seniors often take multiple medications for other health issues, careful consideration is needed to avoid adverse interactions.

• Medication Selection: Newer anti-seizure medications with fewer side effects and drug interactions are often preferred. The principle of "start low and go slow" is particularly important for older adults due to age-related changes in metabolism.
• Underlying Cause: Addressing the underlying cause, such as managing vascular risk factors after a stroke, can be a critical part of treatment.
• Lifestyle Adjustments: Proper sleep hygiene, a balanced diet, and stress management are all beneficial lifestyle factors for managing seizures.

While the prognosis for seizure control is generally favorable, older adults with epilepsy face higher risks of comorbidities like stroke and dementia, which can affect long-term outcomes. Regular monitoring and follow-up with a specialist are vital for maintaining the best possible quality of life.

Conclusion: A High Index of Suspicion is Key

In summary, while classic absence seizures are not common in older adults, it is a fallacy to assume they can't occur. The possibility, however rare, coupled with the higher incidence of late-onset epilepsy, means a high index of suspicion is required. The brief, subtle symptoms can easily be missed or misdiagnosed as other age-related conditions. Early and accurate diagnosis, guided by a thorough medical history, EEG, and brain imaging, is the most critical step. Effective management with appropriate medication can lead to significant seizure control and a good quality of life for seniors with late-onset epilepsy. Consulting an epilepsy specialist or epileptologist is recommended for a precise diagnosis and tailored treatment plan, especially when symptoms are unclear or persistent. For more information on epilepsy in older adults, the Epilepsy Foundation is an excellent resource.

Frequently Asked Questions

Can older adults develop epilepsy from a stroke?

Yes, stroke is a leading cause of new-onset epilepsy in older adults. The brain damage resulting from a stroke can create an environment where seizures are more likely to occur, sometimes months or years later.

How are absence seizures in older adults different from children?

While children typically have classic absence seizures, older adults are more likely to experience focal seizures with impaired awareness that mimic the staring spells of an absence seizure. The duration may be longer, and a period of confusion often follows.

What are the common misdiagnoses for seizures in seniors?

Seizures in older adults are frequently mistaken for other conditions, including dementia, delirium, transient ischemic attacks (TIAs), syncope (fainting), and psychiatric disorders due to the often subtle and non-convulsive nature of the symptoms.

Does Alzheimer's disease increase the risk of seizures?

Yes, neurodegenerative disorders like Alzheimer's disease significantly increase the risk of seizures in older adults. The ongoing changes in brain structure can lead to electrical instability and seizures.

How is the diagnosis of a seizure confirmed in an older adult?

A diagnosis is confirmed through a combination of a detailed medical history, an EEG to record brain activity (often an ambulatory EEG over several days), and brain imaging like an MRI to check for structural causes.

Can medication trigger seizures in older adults?

Yes, certain medications can lower the seizure threshold and increase risk. This includes some antibiotics, pain medications, and psychiatric drugs. Polypharmacy, the use of multiple medications, is a particular concern in seniors.

What is the prognosis for late-onset epilepsy?

The prognosis for seizure control in late-onset epilepsy is often very good with the right treatment. However, managing underlying causes and comorbidities is crucial for overall long-term health and quality of life.