UNCORRECTED PROOF 1 2 The psychosocial impact of epilepsy in older people 3 Ludger Tebartz van Elst a, * , Gus Baker b , Mike Kerr c,d 4 a Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany 5 b Division of Neurological Sciences, University of Liverpool, UK 6 c Welsh Centre for Learning Disability, Cardiff University, UK 7 d Welsh Epilepsy Research Network, UK 8 10 article info 11 Article history: 12 Received 4 March 2009 13 Accepted 5 March 2009 14 Available online xxxx 15 Keywords: 16 Older people 17 Epilepsy 18 Causation 19 Depression 20 Stroke psychosocial impact 21 22 abstract 23 Given a prevalence of 0.5–1% the epilepsies belong to the most common of neuropsychiatric diseases. 24 Many clinicians think of the epilepsies as an entity beginning in early in life. However, the peak incidence 25 of epilepsy in the developed world is now in the age group beyond 60 years. This population has thus an 26 increasing importance; and in this paper we want to review and summarize the specific aspects of the 27 clinical presentation, etiology, diagnosis, and treatment of older-age patients with epilepsy. In particular, 28 we want to focus on the specific psychosocial impact epilepsy has on the life of older people with epilepsy 29 and their carers. 30 Ó 2009 Elsevier Inc. All rights reserved. 31 32 33 1. Introduction 34 In societies with developed economies older age is the most 35 common time in life to develop new onset epilepsy. This is partially 36 due to the fact that life expectancy is increasing. Along with this 37 the prevalence of age-related neurological disorders such as neuro- 38 vascular disorders, some malignancies and dementia are increas- 39 ing. Since these disorders are associated with an increased risk 40 for the development of seizures, the peak incidence of epilepsy is 41 in now older age in developed societies [1,2]. 42 In contrast to this development many doctors and medical pro- 43 fessionals have tended to think of the epilepsies as a group of dis- 44 orders that generally have their origin early in life [3]. The general 45 focus of epilepsy research has not been in the elder population and 46 is thus not meeting the clinical need. There is, in fact, a general 47 paucity of studies addressing the issue of epilepsy in older age. 48 Those that exist have highlighted specific differences in epilepsy 49 in older age in contrast to early onset epilepsy in terms of the clin- 50 ical manifestation, the etiologies, the treatment, and the psychoso- 51 cial impact the epilepsy has on the life of the affected patients and 52 their carers [4,5]. Therefore, this paper will review and summarize 53 specific aspects of epilepsy in older people and the psychosocial 54 burden epilepsy has in this group of patients. 55 2. Epidemiological aspects 56 Whereas the prevalence of active epilepsy is about 0.5–1% in the 57 general population approximately 1.5% of the population over the 58 age of 70 years are diagnosed with active epilepsy [2,6,7]. In this 59 context poststroke epilepsy is one of the most important causes 60 accounting for about 40% in older people and for 11% of all seizures 61 [2,7]. The prevalence of epilepsy across the life span increases from 62 about 3/1000 in the first decade to about 8/1000 in the age group 63 of older than 80 years. The incidence increases from about 6/ 64 10,000 in the first decade to about 14–16/10,000 in the age group 65 with a first peak of incidence in the second decade and a second 66 larger peak after the age of 70 years [1,2,6,7]. These figures illus- 67 trate the enormous impact epilepsy has in the lives of older people. 68 3. Clinical presentation of epilepsy in late life 69 Thirty percent of the epilepsies first presenting in older age do 70 so with status epilepticus, which carries with it a mortality risk 71 of 40% [1,2,8–11]. About 70% of the first seizures are described as 72 being of focal onset with or without secondary generalization. 73 However, in contrast to classical early life epilepsy, atypical fea- 74 tures are very common including symptoms like memory lapses, 75 episodes of confusion, periods of inattention, apparent syncope, 76 confusion, and Todd‘s paresis. Since these symptoms may mimic 77 other diseases which are very common in older age such as tran- 78 sient ischemic attacks (TIA), stroke, or dementia the correct diag- 79 nosis is often delayed [12,13]. 1525-5050/$ - see front matter Ó 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.yebeh.2009.03.015 * Corresponding author. Fax: +49 761 270 6619. E-mail address: tebartzvanelst@uniklinik-freiburg.de (L.T. van Elst). Epilepsy & Behavior xxx (2009) xxx–xxx Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh YEBEH 1874 No. of Pages 3, Model 5G 31 March 2009 Disk Used ARTICLE IN PRESS Please cite this article in press as: van Elst LT et al. The psychosocial impact of epilepsy in older people. Epilepsy Behav (2009), doi:10.1016/ j.yebeh.2009.03.015