II. Epidemiology
- Incidence of Seizure Disorder increases after age 60
III. Causes: Acute Symptomatic Seizures (onset after age 60)
- See Seizure Causes
- Cerebrovascular Accident (32%)
- Idiopathic: No identifiable cause (25%)
- Brain Tumor: Meningioma, glioma, metastases (14%)
- Head Trauma with Subdural Hematoma
- CNS Infection (Meningitis, Encephalitis)
- Alzheimer's Dementia
- Metabolic disturbance
- References
IV. Causes: Status Epilepticus (at onset, and over age 60)
- Cerebrovascular Accident (most common)
- Head Trauma
- Other causes
- Hypoxia
- Hyperglycemia
- Brain Tumor: Meningioma, glioma, metastases
- CNS Infection (Meningitis, Encephalitis)
- Drug Intoxication or withdrawal
- References
V. Evaluation and Initial Management
VI. Management
- Determine if Seizure Prophylaxis needed
- Many elderly patients will not have recurrence
- Consider differential diagnosis
- See Seizure Causes
- See above causes
- Indications
- Recurrent Seizures
- Status Epilepticus history
- CNS Lesion
- Medication selection criteria
- Lower cost
- Conveniently dosed (qd to bid)
- Fewer adverse effects
- Lower Drug Interaction risk (and low Protein binding)
- Medication options (start low and go slow)
- Older medications (lower cost)
- Newer medications (less interactions, side effects)