It was a bright morning in June 2023, when octogenarian Radhamani from Bangalore was engaged in her favorite pastime — reading a book. Suddenly, she felt twitching on the right half of her face, which further transcended to her right hand. “We were worried thinking she was having a stroke as she had previously suffered from one in 2010,” says Radhamani’s granddaughter Sahana Suresh. Fortunately, the twitching lasted for no more than three minutes, after which she was rushed to a doctor, and the family learned that it was one of the signs of a seizure. Seizures in elderly people can lead to falls and injuries; thus, it’s crucial to manage and prevent them, say experts.
Radhamani, 88, tells Happiest Health, “I knew something was not right. I could see my family rushing to me, speaking to me but I couldn’t respond or control my movements. I was scared as I had numbness in my face and hand, as well as slurred speech and weakness for a few hours. However, I felt completely normal by the time I was taken to the hospital.”
The onset of seizures or epilepsy is seen early in life and the late onset in older adults requires special attention, says Dr Rima Chaudhari, senior consultant – neurologist and epileptologist, Fortis Hospital, Mulund, Mumbai. “It is important to address seizures in elderly people as the threshold for treatment is very low due to them being frail and on different types of medication. Moreover, there is a high risk of falls,” she explains.
Cause for seizures in elderly
In most cases, elderly persons can have a seizure due to secondary causes such as a prior stroke or a brain injury, says Dr Amit Kulkarni, senior consultant and lead – neurology and stroke, Sparsh Hospital, Bangalore. “When someone has a stroke, it leaves a scar in the brain, which can provoke seizures. The same is the issue with people who undergo neurosurgery,” he shares. He adds that seizures are seen in people who had a trauma or traumatic brain injury.
Other reasons such as metabolic problems like low or high sodium and low calcium can also cause seizures. “Sometimes, the drugs taken to control issues such as high blood pressure or routinely prescribed antibiotics for urine infections can also increase the risk of seizures,” he said.
Dr Chaudhari explained that a seizure may be the initial or only manifestation of a brain tumor along with a headache. “We also see people with sleep apnea having seizures triggered in their sleep. All of these are rare causes which we don’t see often,” she said.
Do all seizures lead to falls?
Not all seizures lead to falls, clarifies Dr Kulkarni. However, experts advise people with seizures against riding or driving to avoid accidents. Seizures can be broadly classified into two types — generalized and partial or focal seizures. Dr Kulkarni further explains, “Not all partial seizures lead to a fall. On the other hand, a generalized seizure often leads to a fall.” Seizures associated with falls are called generalized tonic-clonic seizures.
Partial seizures are further categorized as simple partial and complex partial.
Simple partial seizure: This involves one particular part of the brain and the electrical activity does not spread to the other part of the brain. For instance, if someone has a seizure in the left frontal lobe, the person will have sudden jerking of the right side of the face and the right hand. Similarly, if the seizures occur in the right frontal lobe, the twitching will be noticed on the left.
Complex partial seizures: Loss of awareness is associated with complex partial seizures, says Dr Kulkarni. “An older person could be engaged in an activity when they suddenly stop and stare to one side. They may also have some automatic movements — blinking, facial grimacing, or drooling saliva — without being aware of them. After a minute or two, they might resume without any recollection of the event.”
These symptoms were similar to what happened with US Senate minority leader Mitch McConnell, 81, during his regular weekly Republican leadership news conference in September 2023, when he appeared to freeze up while taking questions. Though a seizure or stroke was initially suspected, no evidence was found. Hence, it was dismissed as momentary light-headedness.
Ways to prevent recurrent seizures
Strict adherence to the prescribed medicines can prevent recurrent seizures, say doctors. If someone has a seizure, taking medications on time is crucial to prevent falls, Dr Kulkarni says. Moreover, dehydration is a major concern in older people as it may result in dizziness and falls. While drinking sufficient fluids, it is crucial to get adequate sleep, too. One should also avoid driving or riding a vehicle.
Dr Chaudhari said that the treatment for seizures does not vary much among elderly people — it largely remains the same. “We look into the medical conditions, the drugs they are on, and speak to the family and caretakers before prescribing new medications,” she said.
- Seizures in elderly people require special attention as they could lead to falls and injuries.
- Most seizures in older people occur due to secondary causes such as a history of stroke, brain injury, or neurosurgery that left a scar in the brain.
- To prevent recurrent seizures, people should take their medication on time. Adequate hydration and sleep are also crucial.