Epilepsy, a neurological disorder marked by recurrent, unprovoked seizures, can manifest at any point in life. While commonly associated with childhood, this condition can emerge from infancy through late adulthood. An epileptic seizure represents a transient event resulting from abnormal, excessive, or synchronized electrical activity within the brain. Recognizing that epilepsy is not confined to a single age group is important for understanding its varied presentations.
Epilepsy Onset: A Lifelong Possibility
Epilepsy onset demonstrates a bimodal distribution, meaning it has two distinct peaks in incidence across the lifespan. The first peak occurs in early childhood, especially during the first year of life. The second and higher peak is observed in older adulthood, especially in those over 60. The rate of new cases generally decreases from age one until around age ten, remaining relatively stable through adolescence and middle adulthood. However, new cases can arise at any age in between these peaks.
Studies indicate that the incidence of epilepsy is currently higher in older individuals compared to children. For instance, people over 65 account for a notable proportion of new-onset epilepsy cases. This means individuals may experience their first unprovoked seizure at any stage, from infancy to their senior years.
Common Causes of Epilepsy by Age
The underlying reasons for epilepsy vary considerably depending on a person’s age at onset. In infants and young children, genetic factors frequently play a role, with some types of epilepsy running in families. Other causes in this age group include birth injuries, such as a lack of oxygen during delivery, developmental brain abnormalities, and infections like meningitis or encephalitis. Metabolic disorders can also contribute to epilepsy in very young children.
For children and adolescents, genetic predispositions remain a factor, alongside acquired causes such as head trauma and brain tumors. Infections affecting the brain can also lead to epilepsy in these age groups. In many cases, particularly in children, the specific cause of epilepsy is not identified, termed idiopathic epilepsy.
In adults, common causes include head trauma from accidents and stroke, especially for those over 35. Brain tumors and central nervous system infections also contribute to adult-onset epilepsy. Autoimmune conditions, where the body’s immune system attacks brain cells, can also be a cause.
Among older adults, stroke is a frequent cause of new-onset epilepsy. Neurodegenerative diseases, such as Alzheimer’s disease and other forms of dementia, also increase the risk of epilepsy in this population. Brain tumors, head trauma, and infections are further contributing factors in older individuals.
Recognizing Symptoms at Any Age
Regardless of age, seizures are the primary manifestation of epilepsy, yet their presentation can differ widely. A seizure results from abnormal electrical activity in the brain, leading to temporary changes in awareness, movement, sensation, or behavior. These changes can range from subtle to pronounced.
Seizures are broadly categorized into generalized and focal types. Generalized seizures involve electrical activity across both sides of the brain from the outset. These can include tonic-clonic seizures, characterized by stiffening and rhythmic jerking movements, or absence seizures, which appear as brief staring spells. Other generalized forms include atonic seizures, causing sudden loss of muscle tone, and myoclonic seizures, presenting as brief muscle jerks.
Focal seizures, in contrast, originate in a specific area on one side of the brain. Symptoms depend on the brain region affected and can occur with or without impaired awareness. These may include altered emotions, unusual sensations like tingling or strange smells, or repetitive movements such as lip smacking or fumbling. In older adults or very young children, seizures can be subtle and might be mistaken for other conditions.
Why Age Matters in Epilepsy
A person’s age significantly influences various aspects of epilepsy, from the types of seizures experienced to the management approach. Certain seizure types are more prevalent in specific age groups; for example, infantile spasms typically occur in infants, and absence seizures are often seen in children. In adults and older individuals, focal seizures are more common.
Diagnosis can present challenges in very young and very old individuals due to less typical seizure presentations or the presence of other health conditions. For instance, in older adults, seizure symptoms like confusion or memory problems might be attributed to aging or other neurological issues, potentially delaying an epilepsy diagnosis.
Treatment approaches are also age-dependent. Medication choices and dosages are carefully selected based on a person’s age due to potential side effects and interactions with other medications, especially in the elderly who may be taking multiple drugs. The impact on development in children also factors into medication decisions. The long-term outlook for epilepsy can vary based on the underlying cause and the age at which the condition first appears.