— Could you please tell us what happens to the human brain during epilepsy attacks?
— The basis of epilepsy is the spontaneous disruption in the electrical activity of brain cells. In other words, in a group of neurons, their activities, cell membrane functions, channels and receptors are disrupted, and as a result, pathological electrical discharges occur.
From the outside, this manifests as different types of seizures, depending on where in the brain the cells are damaged. This could be the frontal lobe, temporal, parietal, occipital, or even the entire brain.
— What kind of attacks do patients experience?
— Epilepsy has many faces. This might be the “classic” type of attack we all imagine well. The patient may lose consciousness, experience convulsions, fall, get injured, foam at the mouth, and experience involuntary urination. He/she may experience confusion after the described attack.
But this is just one of many options. A person closes, but at the same time maintains his posture and does not fall. He or she may no longer be able to understand what others are saying or may not be able to speak clearly to others. Seizures may manifest as startling, freezing, or staring. Sometimes during attacks, patients may move their hands or swallow. Sometimes the patient may feel the visceral sensation of something he or she has seen before or has never seen before. There are also types of attacks when a person feels an increased feeling of nausea.
— So does it all depend on the area of brain damage?
— Yes, depending on the area of damage, its shape and the form of epilepsy. For example, there are generalized epilepsies and focal epilepsies. In generalized forms of epilepsy, we are not talking about areas of brain damage, because, as can be seen from the definition, the entire brain is involved in the process of excessive electricity production.
— You can find information about epileptic syndrome on the Internet. How is it different from epilepsy?
– Great question. The fact is that in Russia epileptic syndrome sounds like a diagnosis when the doctor does not understand what is wrong with the patient, that is, something between epilepsy and something incomprehensible. It is also used for specific tasks.
In fact, in modern world terminology, epilepsy is equivalent to epileptic syndrome. We can say that this syndrome is a detailed form of epilepsy.
— There is such a thing as senile epilepsy. Do they have any distinguishing features?
— Epilepsy in the elderly is the same epilepsy as in young people. This is a chronic brain disease that manifests itself in various types of seizures due to excessive neuronal discharge. However, it does not appear in youth, but after 60 years.
Moreover, epilepsy in old age is as common as in youth and childhood.
Of course, it has its own clinical picture, diagnostic and treatment features, but the essence of the disease remains the same.
— So when we talk about epilepsy in old age, do we mean that we have been healthy all our lives, we do not have a hereditary predisposition to the disease, but suddenly an epileptic attack overtakes us? Why is this happening?
– This occurs due to various brain damage. This can be a stroke, traumatic brain injury, infectious diseases, the same COVID-19, toxic brain damage caused by alcohol or drug use, and much more.
The most interesting thing here is that age itself can be a cause of the development of epilepsy. An elderly person may say with surprise: “My brain scan shows no damage. Where does my epilepsy come from? Then we answer that the reason for your diagnosis is the age factor.
– From where?
— There is such a thing as accumulated damage. If a person once suffered from inflammation or even a minor injury, somewhere he drank for several years, a microstroke occurred somewhere. This means that his brain has suffered from certain factors throughout his life, so epilepsy can begin in old age.
— Are there factors such as stress or fear that could trigger the first attack?
— There is a common belief that a man was walking, his dog frightened him, and he began to have a seizure. This does not happen. As a rule, an attack can start suddenly.
— Can epilepsy in old age be accompanied by any complications, especially a decrease in cognitive functions?
— Of course, but this is valid for all ages. Of course, after the age of 60, a person experiences a natural decline in cognitive functions for various reasons, such as Alzheimer’s disease.
Epilepsy can accelerate this decline but cannot cause it. He won’t have time to do this on his own. Previously, when there was no effective method of treating the disease and the sick person was subjected to constant attacks, it could break down and deteriorate. Today, with appropriate treatment, a patient can easily live to the age of 90.
— Are there any other complications of epilepsy after age 60?
— One of the main complications is fractures resulting from falls. Most often, people after age 60 are diagnosed with osteoporosis (low bone density), so a fall can result in a fatal fracture.
— How is the disease diagnosed in the elderly?
— Epilepsy has many faces and many diseases can be similar to it, so making a diagnosis is no easy task. For example, a person may have an arrhythmia attack and lose consciousness. When he bites his tongue, he will experience convulsions, as in epilepsy. The attack will be accompanied by the same urination. These two situations are indistinguishable from the outside.
There is also the problem of non-epileptic mental seizures. Later, it turns out that epilepsy-like attacks are caused by other diseases.
Also, a seizure may be a symptom indicating the presence of a tumor in the brain or the development of metastases. In general, malignancy cannot be detected until epileptic seizures begin.
– How to distinguish epilepsy?
— Classical methods are used, these are electroencephalography and magnetic resonance imaging. However, we need to “restrain our enthusiasm” when talking about elderly patients.
Often young doctors like to use “disturbing” diagnostic methods. For example, if the patient is deprived of sleep on the eve of electroencephalography, as if provoking an attack, there is a sleep deprivation test. This cannot be done in elderly patients because in an elderly person this may be associated with the development of atrial fibrillation and sudden increases in blood pressure. If you can save the patient from uncomfortable examinations, it is better to do so.
Sometimes it can be difficult to diagnose an elderly patient. For example, he lives alone and does not notice any symptoms. He falls, finds himself lying on the ground, and thinks it’s just old age. Or he doesn’t fall, he just doesn’t understand what’s happening to him. He also attributes this to old age and does not consider epilepsy. Therefore, it is important to monitor your condition, and in case of even the slightest doubt, it is better to consult a specialist.
— You stated that epilepsy treatment in the elderly has its own characteristics. How is it different from therapy for teenagers?
“When we treat teenagers and not children, we can benefit from very aggressive therapy. These are high doses and multiple medications; Some patients may use four or five medications. This never happens in elderly patients, a maximum of two drugs are used.
Three of them are already ordinary.
In addition, as a rule, we do not use surgical treatment tactics, except for pathologies that threaten the patient’s life. Epilepsy is caused by a tumor that grows in the brain, then we perform surgery to remove it.
One more thing: We should choose mild drugs because their bodies are already weakened. For example, carbamazepine (antiepileptic drug) should not be given. This is important to note, because in our country it is still prescribed to people over 60 years old, but this is prohibited by all clinical recommendations.
– Why can’t he be appointed?
– First of all, it is cardiotoxic. All of our elderly patients have cardiac comorbidities, that is, cardiovascular diseases in addition to epilepsy.
Secondly, it reduces the concentration of many concomitantly prescribed drugs. Accordingly, everything our elderly patient takes for blood pressure, arrhythmia and diabetes loses its effect. Not to mention the neurotoxicity, dizziness, or increased risk of falls that we are trying to avoid.
Therefore, in order to improve the quality of life of a patient with epilepsy and reduce the risk of life-threatening complications, it is important to diagnose the disease as early as possible and prescribe medications correctly.