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Epilepsy in Older Adults

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Of the 3 million people in the United States with epilepsy, about a third, or 1 million, are adults age 55 and older. New cases peak in childhood and then again after 55, with the highest rate of new cases occurring in people 75 and older. Epilepsy can be challenging to recognize and manage in older people.1-3

Doctors cannot identify a cause in about half of older adults with epilepsy. Black Americans have the highest rates of new cases of epilepsy. Asian and Native Americans have the lowest rates.1,3

What causes epilepsy in older adults?

Some older adults have been living with epilepsy since childhood or young adulthood. Others develop epilepsy as a result of health conditions that grow more common as we age. Epilepsy becomes more common in those who have:1

  • Stroke
  • Dementia and Alzheimer’s disease
  • Head injuries due to falls
  • Brain tumor
  • Mental health conditions

Stroke is the most common cause of epilepsy in older adults. It accounts for between 3 to 5 out of every 10 new cases. About a third of people who have seizures with their stroke go on to develop post-stroke epilepsy.3

Epilepsy is also more common in those with Alzheimer’s disease. Two out of 10 people with Alzheimer’s will develop seizures, which is much higher than normal. The younger someone is when diagnosed with Alzheimer’s and the more severe the dementia, the higher the risk of having seizures.3

Dementia that is not caused by Alzheimer’s is another risk factor for developing epilepsy.3

Brain tumors, accidents, and falls may damage brain tissue, which in turn leads to epilepsy. Older people are especially vulnerable to head trauma. Up to 2 out of 10 older adults have epilepsy caused by head trauma.3

Recent studies now show that older adults with mental health conditions are more likely to develop epilepsy. This includes adults with:3

  • Substance use disorder
  • Psychosis
  • Bipolar disorder
  • Schizophrenia
  • Depression

Complications of epilepsy in older adults

Epilepsy can be hard to diagnose and manage in older people. In fact, seizures in older adults are often misdiagnosed as something else.3

Part of the reason: Seizures often look different in older adults than in children or young adults. This makes seizures harder to recognize as epilepsy and not another condition common to older adults. For example, an older person may describe feeling dizzy or act confused.3

During a seizure, older adults may:3

  • Appear confused or unresponsive
  • Change behavior
  • Suddenly fall without warning and have no recall
  • Suddenly feel sleepy or fall asleep
  • Wake up confused and disoriented

Older people’s seizures usually lack an aura or jerking or repeated movements. Their seizures may be hard to tell from dementia. Recovery from seizures may take days longer than in younger people.3

Epilepsy can be hard to treat because 8 out of 10 people 65 and older have multiple chronic health conditions. Anti-seizure drugs can be hard to balance with medicines taken for other conditions. Plus, many anti-seizure drugs have side effects like dizziness, bone loss, or effects on the liver, kidney, and bone marrow. Older people can be more susceptible to side effects, making them more likely to fall or be injured.1,2

Epilepsy, especially if someone loses awareness, can interfere with the ability to drive or live alone. This can greatly impact quality of life because it interferes with independence.

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