Long-Term Care

Review Important Considerations for Patients with Epilepsy in Long-Term Care Facilities

Estimated prevalence of epilepsy in adults aged 65+ is up to 570,000.1,2 However, diagnosing epilepsy in older adults may be complex due to its subtle clinical features.3 Since seizures in older adults may appear differently, this may result in older adults being undiagnosed and untreated.2


Epilepsy/seizure is the 5th most common neurological condition in nursing home residents*4

*According to an analysis which evaluated 1,186,579 elderly Medicare/Medicaid patients living in nursing homes from 2003–2007.4

Diagnosing epilepsy in older adults may be challenging3

Factors that may complicate diagnosis

  • Auras and automatisms that are typical in younger patients may be less common in elderly
  • Nonspecific symptoms (eg, confusion, staring)
  • Symptoms are often misattributed to seizure mimickers
    • Syncope
    • Transient global amnesia
    • Transient ischemic attacks

Identifying seizure occurrence in older adults

In ~50% of cases, the cause of epilepsy among older adults is unknown.5 When causal determination can be made, it is most frequently due to stroke (33%).5

Seizure symptoms may include:

  • Briefly distorted vision2
  • Brief loss of speech2
  • Confused speech2
  • Facial twitching2
  • Confusion6
  • Sporadic memory loss6
  • Suspended awareness6
  • Hearing or seeing things6

An older person suspected to have had a seizure should undergo rapid assessment by an epilepsy specialist and treatment initiation if indicated7



  1. Epilepsy Foundation Texas. www.eftx.org/about-epilepsy/. Accessed February 26, 2018.
  2. Epilepsy Foundation Eastern Pennsylvania. www.efepa.org/living-with-epilepsy/seniors-with-epilepsy/. Accessed February 26, 2018.
  3. Chong T, D’Souza W. Epilepsy in the elderly. In: Shorvon S, et al, eds. Oxford Textbook of Epilepsy and Epileptic Seizures. Oxford, United Kingdom: Oxford University Press; 2013:201-210.
  4. Birnbaum AK, Leppik IE, Svendsen K, Eberly LE. Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes. Neurology. 2017;88(8):750–757.
  5. Epilepsy Foundation. Seniors with Epilepsy. https://www.epilepsy.com/learn/special-populations/seniors-and-epilepsy/seniors-epilepsy. Accessed February 8, 2018.
  6. How to spot epilepsy in seniors when it looks like dementia. Brain and Spine Team Cleveland Clinic. https://health.clevelandclinic.org/2014/10/how-to-spot-epilepsy-in-seniors-whenit-looks-like-dementia/. October 14, 2014. Accessed January 31, 2018.
  7. Brodie MJ, Kwan P. Epilepsy in elderly people. BMJ. 2005;331:1317-1322.