Epilepsy and the Elderly Person
Of the total population who are diagnosed with epilepsy for the first time, only 2% are elderly people for the first time, only 2% are elderly people. The physical changes related with ageing are most likely the cause of epilepsy.
CAUSES OF EPILEPSY IN OLDER PEOPLE
Epilepsy in an elderly person could be the return of a seizure disorder that was in remission for many years.
- Strokes can cause seizures because of the hemorrhage and damage to the brain itself.
- Diseases such as heart attacks and Alzheimer's can cause changes in the brain that may lead to seizures.
- Diseases of the kidneys, liver and even diabetes may cause diabetes in later life.
- Alcoholism/alcoholism can trigger seizures or latent epilepsy.
- Brain tumors of any kind may cause seizures.
- Post traumatic and post operative traumas can cause epilepsy.
- Surgery to the brain can leave a scar that may cause seizures.
- Positive family history of epilepsy
- Physical changes of old age
- Multiple sclerosis
- Narrow or clogged arteries
EPILEPSY AND THE PROCESS OF AGING
Decrease in mental alertness, mood changes and memory loss can be caused by several health problems associated with ageing. There may also be other explanations for the change in behavior of the elderly person
The therapeutic levels of anti-convulsant medication need to be monitored through regular blood tests. If the levels are too high it could cause toxicity, which could, in turn, manifest as dizziness and confusion.
- DRUG INTERACTION
The elderly person is most likely taking a variety of medication for different medical reasons. These drugs can interact and produce negative side effects. It is therefore of utmost importance to discuss possible drug interactions with the doctor and/or pharmacist.
A negative reaction to drugs may result in depression, agitation, confusion or loss of memory. Monitor any changes in sleeping eating patterns. It is possible that the person is sensitive to specific drugs. Consult with the doctor and never change or stop medication without the doctor's advice.
THE SOCIAL IMPACT OF EPILEPSY ON THE ELDERLY
- The first seizure is a very traumatic experience with far reaching social consequences
- An elderly person may feel useless and of little value to society. Loneliness, physical changes, the fact that they cannot live independently or drive a vehicle can cause depression. This is even worse for the elderly person with epilepsy
- The elderly person ahs a higher risk of sustaining head injuries or fractures due to frequent falls.
- They may feel as if they have lost control over their own lives and feel uncertain about their future
- The elderly person with epilepsy can become socially isolated
- If the person does not experience an aura (a warning sensation that occurs prior to a seizure) the person will need to adjust accordingly to the DOs and Don'ts.
Memory problems often affect people with epilepsy. Epilepsy medicine works best when blood levels remain steady. The correct dosage must be taken at specific times to maintain blood levels and to achieve optimum therapeutic results.
- It can be difficult to keep track of when to drink what medication and therefore we suggest:
- A pillbox/ dispenser divided into segments according to the time and day is useful
- Pills can also be packed in sachets marked with the specific hour of the day and day of the week
- A wristwatch with an alarm can be helpful to remind someone when to take their medication
- A friend or family member can be asked to assist in keeping track of reordering dates and mark the calendar accordingly.
DO & DONTS
- Remember fire, heat and water are dangerous to any person with epilepsy
- Do not smoke or abuse alcohol if you have epilepsy
- Avoid carrying hot dishes or boiling water in a kettle
- Set the water temperature on the geyser lower to prevent the water from burning you.
- Do not bath or shower in excessively hot water as it may bring on seizures
- Avoid ironing if at all possible
- You can drown in very little water. If possible shower instead of taking a bath and do not lock the bathroom door.
- Wear rubber gloves when handling or washing glassware
- Place a screen in front of open fires and do not carry hot ashes
- If possible avoid staying in a house or flat with stairs. You may fall down on the stairs while having a seizure
- Carpeted floors and padded furniture provide more protection.
- Protective and padding can be used on sharp corners of tables to prevent injuries.
- Keep in touch with family or friends with beepers and/or portable phones.
- A medic Alert bracelet can be useful to identify a person while having a seizure enabling the public to be of assistance.
IT IS IMPORTANT TO REMEMBER:
- Do not emphasise what the elderly can do, not what he or she cannot do (while at the same time taking sensible precautions).
- Do treat the elderly person like everyone else in the family.
- Do help your elderly integrate into as many social activities as possible, with the necessary precautions, enabling a health social life.
- Do allow the elderly person to make his/her own decisions where possible.
- Don't over protect the elderly. Allow the person to identify his or her own strengths and weaknesses.
- Don't blame the elderly's epilepsy if the family experiences difficulties.
Should you have any further concerns about taking care of the elderly you can contact an Epilepsy Support Association Uganda which offers advice on various issues concerning the elderly.
EPILEPSY AND WOMEN
Our bodies experience many physical changes throughout our lifetime, and there's no evidence to suggest that epilepsy interferes with this process. Epilepsy has specific implications for women in respect of their gynaecological health and child bearing
FEMALE BIOLOGICAL CHANGES
Menstruation: - There is no evidence to suggest that women with epilepsy experience any major differences in their menstrual patterns. Some women may find a change in seizure pattern, with an increase in seizures either during their period or at the time of ovulation.
Menopause: - The menopause usually occurs between your mid 40's to mid 50's and may have unpleasant symptoms such as hot flushes and night sweats. Hormone replacement Therapy (HRT) may be prescribed to relieve these symptoms.
There is no medical proof to indicate an association between epilepsy and menopausal changes or that HRT influences seizure control or the absorption of anti-epileptic drugs. If you suffer from osteoporosis and if seizures are a problem, this could be a problem.
YOU AND YOUR PARTNER
Relationships: - It is understandable that women with epilepsy may be anxious about establishing intimate relationships but many do form satisfying stable relationships. To do this it is important that both of you are open with each other and discuss your epilepsy and its implications for your life together.
Sex drive: - In as small number of people, epilepsy and anti-epileptic drugs may cause a slightly lower sex drive. For most people this is not a problem and they are able to enjoy sexual intercourse.
Fertility: - Research has shown that a limited number of women may have a lower fertility rate due to epilepsy. But there is no reason to believe that anti-epileptic drugs will reduce your fertility.
Contraception: - Women with epilepsy can choose from all the contraceptive methods available. Your doctor will be able to advise which is the most suitable for you. It's important to note that the effectiveness of some forms of the pill can be reduced by anti-epileptic drugs and higher doses may be necessary to provide adequate contraception.
Heredity: - The chance of passing epilepsy on to your children will depend on the type of epilepsy you have and other factors. If you've had it since birth there's about a 6% chance that your child will also have it too.
PREGNANCY AND BIRTH
Family planning counseling: - If you are thinking about having a baby, its best to discuss the matter with your doctor before becoming pregnant. This will allow you to gather all the information you need in order to decide on planning your family.
Your partner should join you in counseling to share his concerns and to be informed of the possible risks to you and your baby's health.
Anti-epileptic medication: - Before becoming pregnant it is important to discuss your medication with your doctor as it may need to be changed to minimize the risks to your baby. Some drugs can affect the growing feotus so it is essential that this be checked out with your doctor as soon as possible. Generally it is preferable to remain on medication with the small risks this may carry rather than to withdraw all drugs and risk loosing control of your seizures.
Seizure patterns: - Some women experience changes in their seizure pattern during pregnancy. There may be a slight increase or decrease in frequency.
Diet: - Some anti-epileptic drugs may reduce vitamin K in the bloodstream which can affect the clotting mechanism in the blood. In such cases the doctor may recommend that vitamin K is taken by the mother before delivery and by the baby for a short while after birth. Some drugs are known to increase the risk of neural tube defect such as spina bifida.
It is advisable that all pregnant women but in particular those with epilepsy should take a folic acid supplement during pregnancy.
Medical check-ups:-It's important to see your doctor regularly during pregnancy. You should report any seizures or incidents which have occurred such as falls, vomiting, illness or injury.
DELIVERY & CARING FOR YOUR BABY
Labour: - Your labour and the delivery of your baby are not likely to be different from that of other mothers. By taking your medication correctly and getting as much rest as possible, you will reduce the risk of having a seizure during labour.
Remember that you will not be alone during this time and immediately after the birth.
Breastfeeding: - The likelihood of your baby being affected by anti-epileptic drugs present in your mild will depend on the medication you take. In the majority of cases very little of the drug is passed on to the infant and should not pose a problem. In fact, this may be a way of weaning your baby of the medication that would have been absorbed during pregnancy.
If you tend to have seizures without warning, it is advisable that you take precautions while feeding your baby. You could try sitting on the floor with your back on the wall surrounded by cushions.
Bathing and changing your baby: - Using a bath stand could be risky so it's best to put the baby bath on the floor. If you feel this is still too risky and there is no one to assist you, it may be best to sponge your down on a waterproof sheet. Changing your baby in the cot or on a blanket on the floor is a good idea. By kneeling to the side, you will fall away from your baby should the seizure occur.
Sleep: - Having a new baby in the home is physically and emotionally draining. Make sure to get plenty of rest and accept any offers of assistance you get from friends and relatives.
Parenthood: - Like all new parents you and your partner will find parenthood exciting and challenging. The pleasure you get from your baby should not be affected in any way by the fact that you have epilepsy.