• Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


Epilepsy often develops for the first time in old age. The active epilepsy prevalence rate is approaching 1.5% amongst the 65 years and older which is about twice the rate of younger people. Aetiology of seizures varies amongst the different age groups. In the elderly, cerebrovascular and neurodegenerative diseases are the leading causes of epilepsy. In the elderly, stroke is the common cause of seizures. Status epilepticus occurs in 12% of stroke patients and remains a life-threatening event. Periodic lateralising epileptiform discharges (PLEDs) have been commonly associated with cerebral infarction but also with other cerebral diseases such as encephalitis, tumour and demyelinating diseases. Manifestations depend on the type of seizure which may be classified as partial (focal) or generalised. Elderly individuals who have seizures must be carefully evaluated. Investigations should include neuroimaging. A common manifestation of epilepsy in the elderly is non-convulsive status epilepticus (NCSE). Most elderly people respond well to antiepileptic drugs (AEDs) including low doses of AED and are more likely to remain seizure-free than the younger patients. Monotherapy is the main goal of epileptic treatment, and majority can be controlled on a single agent. The doses that seem to be more appropriate are in the lower levels than the therapeutic ones, and the clinician is best placed to decide. Patients with epilepsy have neuropsychological impairments including emotional distress, behavioural disorders and social isolation and the quality of life.


Epilepsy Seizures Status epilepticus Periodic lateralising epileptiform discharges (PLEDs) Non-convulsive status epilepticus (NCSE) 


  1. 1.
    Fisher RS, van EmdeBoas W, Blume W, Elger C, Genton BE, Lee P, et al. Epileptic seizures and epilepsy: Definitions proposed by the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4) :470–472.CrossRefPubMedGoogle Scholar
  2. 2.
    ILAE: Epilepsy-A new Definition. Retrieved 20 February 2015.
  3. 3.
    Hauser WA. Epidemiology of seizures in the elderly. In Rowan AJ, Ramsay PE. Seizures and Epilepsy in the elderly. Butterworth-Heinmann 1997:7–20.Google Scholar
  4. 4.
    Leppik IE.Treatment of epilepsy in the elderly. Epilepsy Curr 2001;2:46–47.CrossRefGoogle Scholar
  5. 5.
    Beyenburg S, Bauer J, Reuber M. New drugs for the treatment of epilepsy:a practical approach. Postgrad Med J. 2004;80:581–587.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Silverman IE, Restrepo L, Mathews GC. Poststroke seizures. Arch Neurol. 2002; 59: 195–201.CrossRefPubMedGoogle Scholar
  7. 7.
    Teasell R, McRae M, Wiebe S. Poststroke seizures in stroke rehabilitation patients. J Stroke Cerebrovas Dis. 2003; 8: 84–87.CrossRefGoogle Scholar
  8. 8.
    Olsen TS. Poststroke epilepsy. Curr Athroscler Rep. 2001; 3: 340–4.CrossRefGoogle Scholar
  9. 9.
    De Reuck JI. Management of stroke-related seizures. Eur Neuro Dis. 2008; 11: –seizures. 1/02/2010.Google Scholar
  10. 10.
    Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules. Eur J Neurol as quoted by Brodie and Kwan, 2005.Google Scholar
  11. 11.
    Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester. Minnesota :1935–1984. Epilepsia. 1993; 34: 453–68.CrossRefPubMedGoogle Scholar
  12. 12.
    Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ. 2005; 331: 1317–22.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Marson A, Jacoby A, Johnson A Kim L, Gamble C, Chadwick D. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomized controlled trial. Lancet. 2005;365:2007–13.CrossRefPubMedGoogle Scholar
  14. 14.
    Kelly KM. Poststroke seizures and epilepsy: Clinical study and animal models. Epilepsy Curr. 2002; 2(6): 873–877.CrossRefGoogle Scholar
  15. 15.
    Asconape JJ, Penry JK. Poststroke seizures in the elderly. Clin Geriatr Med 1991;7(3): 483–92.PubMedGoogle Scholar
  16. 16.
    Velioglu S, Ozmenoglu M, Biz C, Alioglu Z. Status epilepticus after stroke. Stroke. 2001;32:1169–1172.CrossRefPubMedGoogle Scholar
  17. 17.
    Dan YF, Pan ABS, Lun SH. PLEDs: aetiology and association with EEG seizures. Neurology. (Asia) 2004; 9: 107–108.Google Scholar
  18. 18.
    Holmes GL. The EEG as a predictor of seizures following cerebral infarction. Clinical EEG Electroencephalography.1980;11(2):83–86.CrossRefPubMedGoogle Scholar
  19. 19.
    Snodgrass SM, Kenji T, Cosimo AM. Clinical significance of PLED-relationship with status epilepticus. J Clin Neurophysiol 1989;6 (2):159:172.CrossRefPubMedGoogle Scholar
  20. 20.
    Elizawahry H, Hernandez-Frau PE, Behrouz R, Clark WM. Hyperperfusion in stroke. e Medicine Neurology. Updated 24 June 2009. accessed 15/08/2010.
  21. 21.
    Kwan P, Brodie MJ. Clinical trials of antiepileptic medications in newly diagnosed patients with epilepsy, Neurology 2003; 60 (suppl 4): S2–12.CrossRefPubMedGoogle Scholar
  22. 22.
    Holmes GL. The complex phenomenon of epilepsy in the elderly assessed on 11/14/2008.
  23. 23.
    Bottaro FJ, Reisin RC, Martinez OA, Bruetman JE, Reisin CC, Pardal M, et al. Nonconvulsive status epilepticus (NSCE) in the elderly population: a case –control study. Program and abstracts of the American Epilepsy Society 58th Annual Meeting; December 3–7. 2004: New Orleans. Louisiana. Abstract 1.181.Google Scholar
  24. 24.
    Sheth RD, Drazkowski JF, Sirven JL,Gidel BE, Herman BP. Unrecognised status epilepticus in the elderly. Program and abstracts of the American Epilepsy Society 58th Annual Meeting: December 3–7, 2004; New Orleans Louisiana. Abstract 2.226.Google Scholar
  25. 25.
    Myint PK, Staufenberg EFA, Sabanathan K. Poststroke seizure and poststroke epilepsy. Postgrad Med J. 2006; 82: 568–572.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Waterhouse E. Status epilepticus in acute settings. Epilepsy Curr. 2002; 2: 43–44.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Bromfield EB, Henderson GV. Treatment of seizures. 1/02. 2010.
  28. 28.
    Ettinger AB. Diagnosing and treating epilepsy in the elderly. US Neurological Disease 2007. Accessed 11/14/2008.
  29. 29.
    Reike S, Andreas S. Topiramate in elderly patients with epilepsy. Program and abstracts of the American Epilepsy Society 58th Annual Meeting December 3–7 2004, New Orleans, Lousiana. Abstract 2,358.Google Scholar
  30. 30.
    Gandelman-Marton R, Neufeld MY. Epilepsy in the elderly. Harefuah. 2009;148(1):46–9.PubMedGoogle Scholar
  31. 31.
    Nikl J. Epilepsy in the elderly. Ideggyogy Sz. 2011;64(3–4):78–87.PubMedGoogle Scholar
  32. 32.
    Kwan P, Brodie MJ. Early identification of refractory epilepsy. NEJM. 2000;342:314–19.CrossRefPubMedGoogle Scholar
  33. 33.
    American Epilepsy Society 58th Annual Meeting;December 3–7, 2004, New Orleans, Louisiana. Abstract 1.181.Google Scholar
  34. 34.
    Johannessen S, Tomson T. Pharmakinetic variability of newer antiepileptic drugs: when is monitoring needed? Clin Pharmacokinet. 2006;45(11):1061–75.CrossRefPubMedGoogle Scholar
  35. 35.
    Walia KS, Khan EA, Ko DH, Raza SS, Kahn YN. Side-effects of antiepileptics-a review. Pain Pract. 2004;4(3):194–203.CrossRefPubMedGoogle Scholar
  36. 36.
    Epileptic Society. List of anti-epileptic drugs(AED). retrieve 22 February 2015.
  37. 37.
    Australian Prescriber.Zonisamide. Aust Prescr. 2011;34:55–9.Google Scholar
  38. 38.
  39. 39.
    Stefan H, May TW, Pfafflin M, Brandt C, Furatsch N, Schmitz B, et al. Epilepsy I the elderly: comparing clinical characteristics with younger patients. Acta Neurol Scand. 2014;129(5):283–93.CrossRefPubMedGoogle Scholar
  40. 40.
    Johnston A, Smith PEM. Epilepsy in the elderly. Expert Rev Neurother. 2010;10(12):1988–1910.CrossRefGoogle Scholar
  41. 41.
    Meador KJ. Research use of the new quality –of-life in epilepsy inventory. Epilepsia. 1993;3Suppl 4:S34–8.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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