Why epilepsy risk increases after age 60

Most people know they’re at increased risk for certain health conditions as they age: heart disease, stroke, cancer, arthritis, etc.

But there’s a risk you may not be aware of: epilepsy.

Epilepsy tends to make its first appearance during two stages of life: childhood and after age 60. About 447,000 adults older than 65 in the United States have epilepsy, or about 1 percent of that population. That would translate to nearly 800 Washington, D.C., residents who are older than 65. And up to 10 percent of patients in nursing homes are on anti-epileptic drugs.

"A person’s risk of epilepsy spikes in childhood and again after age 60." via @MedStarWHC

There are challenges to diagnosing and treating epilepsy in older adults that don’t exist in young people. As our population ages and we live longer, we can expect to see more adults with epilepsy in the future, so it’s important to understand what can trigger epilepsy as we age and recognize the symptoms, both in ourselves and our loved ones.  

What causes epilepsy in seniors?

Epilepsy in children tends to have a genetic component. But in seniors, it’s often the result of an underlying condition.

 About half of the time, we don’t know why a senior citizen develops epilepsy. For the rest, we usually can trace the cause:

  • Stroke (33 percent)
  • Neurodegenerative disorders such as Alzheimer’s disease (11 percent)
  • Tumors (5 percent)
  • Head injury (2 percent)
  • Infection (1 percent)  

When epilepsy arises from one of these causes, seizures almost always start in one part of the brain, known as focal onset epilepsy. This is in contrast to generalized seizures, which start in multiple areas of the brain. Generalized seizures almost never begin in adulthood.  

If you have a stroke or suffer a head injury, seizures may not start immediately. When I tell a patient a stroke may have triggered their epilepsy, they often say, “But that was over a year ago.” It may take a year or more after the event for seizures to appear. This is because it can take that long for the damaged area of the brain to rewire itself. 

"A stroke can trigger epilepsy, but seizures may not start until a year or more after the event." via @MedStarWHC

Epilepsy symptoms in seniors

It sometimes can be difficult to recognize seizures in older adults. Most people think of seizures as causing muscle jerks or spasms. But seizures can have more subtle symptoms, such as staring spells, chewing or nonsense speech, for example. They occur when a smaller, specific area of the brain is affected, such as with focal onset epilepsy.  

Unfortunately, these symptoms often are mistaken as dementia or waved off as a sign of someone “just getting older.” Some people also may go to the emergency room because they think they’re experiencing symptoms of another medical condition, such as a stroke.  

Symptoms of focal seizures include:

  • Confusion
  • Hearing or seeing things that aren’t there
  • Memory loss
  • Repetitive motions such as chewing, lip smacking or mumbling
  • Shifts in mood, such as becoming agitated or belligerent
  • Staring into space or appearing “out of it”  

After one of these seizures, the person may become sleepy but eventually act like themselves again. They may not remember what happened.  

If a person lives alone or with someone who doesn’t recognize these red flags, seizures can go on undetected for months or years.  

The first step to control seizures is to make a diagnosis. If you or a loved one is experiencing any of these symptoms, including if their behavior has changed or they look like they’re spacing out, talk to a doctor right away.  

Request an appointment.

Some people are embarrassed to admit they’re experiencing hallucinations, confusion or “losing time” during the day. Talk to loved ones regularly about their health. Make them feel comfortable about honestly telling you what’s happening in their daily lives.

Challenges in treating epilepsy in seniors

Focal onset epilepsy often is easier to treat than generalized seizures. If medication doesn’t control the seizures, surgery may be an option.  

This doesn’t mean we don’t face challenges in treating seniors with epilepsy. Many older adults take medications for conditions such as high blood pressure, high cholesterol and diabetes. This means we need to find an anti-epileptic medication that doesn’t interact with these drugs.

Anti-epileptic medications need to be taken consistently to keep seizures under control. This means taking it at the same time every day. This can be a challenge for anyone, not just seniors, and it’s compounded if you’re taking multiple medications every day. Your doctor can recommend tips for better medication adherence, such as using a weekly or monthly pill box or setting an alarm on your phone.  

It’s likely we’ll see more cases of epilepsy in people older than 60 in the coming years, but with increased awareness and early diagnosis, these patients will have a better chance to control seizures and maintain their quality of life. 

How to get better shut-eye when you work night shifts

Job duties can pose various dangers to workers’ health: handling chemicals, operating heavy machinery, even sitting for hours on end in an office every day. But the schedule you work also can put you at greater risk for conditions such as heart disease, depression and cancer.  

While the traditional 9-to-5 workday is not entirely a thing of the past, more Americans than ever – nearly 15 percent – work hours outside that schedule or work shifts that rotate between day and night. These employees keep the country moving 24 hours a day and include police officers, truck drivers, manufacturing workers and my colleagues here at the hospital.  

These types of schedules, known as shift work, pose various challenges to daily life – but sleep often is the biggest one. The resulting difficulty sleeping or excessive fatigue even has a name: shift work disorder. It’s estimated that up to 10 percent of shift workers suffer from this condition.  

An October 2016 study found that:

  • 30 percent of shift workers reported poor sleep quality
  • 61 percent of night shift workers reported short sleep duration, or sleep lasting less than seven hours
  • More than 40 percent required more than 30 minutes to fall asleep
  • 18 percent of night shift workers reported having insomnia  

If you are one of the 20,000 shift workers in the United States, it’s important to understand the dangers sleep deprivation can pose to your health, how to improve your sleep and when to seek help.

Potential dangers related to shift work sleep disorder

Just like anyone who doesn’t get enough quality sleep, shift workers are at increased risk for accidents and work-related errors. It also can cause them to become irritable or depressed. But lack of sleep due to shift work also can affect your health.  

Our circadian rhythm controls the production of hormones such as melatonin, which causes drowsiness, and growth hormones that help repair and restore body processes during deep sleep. While our circadian rhythm is partially driven by natural factors, it’s also influenced by our environment, especially light. When there is less light, like at night, our brain tells our circadian rhythm to make more melatonin so we fall asleep. During the day, we produce less melatonin, so we stay awake.  

Although we don’t understand exactly how, researchers have found that disrupting the circadian rhythm can trigger changes in the body at a molecular level. In fact, the World Health Organization in 2007 deemed shift work a probable carcinogen due to a potential connection between cancer and night shifts.  

In a 2015 study, researchers found that in nurses who worked rotating night shifts:

  • 11 percent had a shortened lifespan after at least six years.
  • The risk of death from cardiovascular disease increased by 23 percent after 15 years.
  • The risk of death from lung cancer increased by 25 percent after 15 years.  

Sleep restores our bodies. Without it, you may become irritable or depressed, and your short-term memory may suffer. Poor sleep also can impair the immune system, which can mean you’re at increased risk of catching a cold or the flu.  

Shift work doesn’t mean you’re doomed to poor health. There are steps you can take to improve your sleep, and if that doesn’t work, your doctor may be able to help.

How to improve sleep when you work odd shifts

Just like anyone else, shift workers need to make sleep a priority. And preparing your body for sleep starts before you even get home from work.

  • Wear sunglasses on your way home: This prevents the sunlight from confusing your body about what you want it to do.
  • Close the blinds when you get home: Darkness will tell your body it’s time to sleep. 
  • Tell friends and family when you will be sleeping: This hopefully will keep them from waking you with visits and phone calls.
  • Keep to your sleep schedule: Go to bed and wake up at the same time as often as you can – even on your days off.  

If you practice good sleep habits and still struggle with your sleep schedule, see your doctor. They may recommend or prescribe a wake-promoting agent, which can make you less sleepy while you work, and a melatonin supplement or sleeping pill to help you get better rest.  

When to seek help for shift work disorder

Adjusting to a shift work schedule does require some patience. It can take months to adjust to a shift work sleep schedule. And if you go back to a “normal” schedule, it also may take time to readjust to sleeping during night hours.  

But because sleep plays such an essential role in our health, it’s important to see your doctor when you’re not getting enough of it for a prolonged period of time.  

Unfortunately, many people with shift work disorder never see a doctor – or wait until it’s causing serious problems. Some think that working night or rotating hours just means they have to deal with poor sleep. They don’t realize there are options to improve or treat it.  

Request an appointment if you’re experiencing any of these symptoms:

  • Difficulty falling asleep  
  • Excessive sleepiness or falling asleep during work hours
  • Insomnia, or not getting an uninterrupted six to eight hours of sleep
  • Irritability or depression
  • Sleep that doesn’t feel refreshing  

Your doctor will ask about your health history and sleep habits. Consider keeping a sleep diary, which can help your doctor assess and monitor your sleep habits. Here’s what you should include:

  • The times you went to bed and woke up
  • How often you awoke up during the “night” and for how long
  • What you ate and drank before going to sleep
  • Whether you exercised and when  

Your doctor also may recommend a sleep study, which we will perform during your normal sleep hours. This can help rule out other sleep disorders, such as sleep apnea. Once we determine a cause, we can recommend behavioral changes or medical treatment.  

Poor sleep is not normal or something you just have to deal with – no matter your work schedule. There are things you and your doctor can do to help you get a good night’s rest.  

When to see a headache specialist for migraine relief

More than 38 million people in the U.S. are affected by migraines, a neurological disorder that causes intense headache episodes. That’s about 12 percent of the country’s population. And despite the availability of effective treatment options, it’s estimated that at least half of people with migraine are undertreated – and most don’t seek help from a doctor.  

"At least half of people with #migraine are undertreated – and most don’t seek help from a doctor.” via @MedStarWHC

Migraine causes a range of symptoms beyond headaches. These symptoms often are debilitating -- more than 90 percent of people with migraine are unable to work or function normally during an episode.

Migraine symptoms can include:

  • Throbbing or pulsating pain
  • Light, smell and sound sensitivity
  • Nausea
  • Blurred vision    

As a headache specialist, people often tell me they’ve tried over-the-counter (OTC) medications and various remedies to find migraine relief, to no avail. I assure them that there are other options, and that they don’t have to accept painful, debilitating migraines as a regular part of their lives. But for every person who seeks treatment from a specialist, there are countless others who choose not to.  

Why is that the case? For one thing, many people aren’t aware they’re having migraines. They’ve never been diagnosed, and they’re hesitant to seek care when they think they “just have a headache.”  

And going to the doctor takes time. It’s faster to stop by the pharmacy and pick up an OTC headache medication. But that time you saved won’t mean much if you’re laid up with migraine symptoms later when the OTC medication doesn’t work. Neurologists like me can prescribe more effective treatments than you’d find at the drug store.    

When to see a headache specialist for migraines

The frequency, length and severity of migraine episodes vary – some people have migraine headaches that last a few hours, while others are cooped up in bed with debilitating symptoms for days at a time.  

With so much variance, it’s difficult to give a broad recommendation on the symptoms that indicate when you should seek migraine treatment. But here’s a good rule of thumb: If your migraines are frequent or severe and proper use of OTC medications isn’t helping, it’s time to seek treatment from a specialist. 

By “proper” use of OTC medications, I mean that you should take the recommended dosage as early as possible during a migraine episode. If you wait to see how bad the migraine will be before you take medication, it’s less likely to work.

Some people with migraines find relief from OTC medications. Yet many people aren’t satisfied with the results or suffer such severe symptoms that OTC drugs don’t help. Additionally, if you rely on migraine medications too heavily, they actually can make migraine symptoms worse.  

This condition – known as rebound headache – occurs when the effects of a medication dose wear off, and people take more medication. If these people take medications too often, they can begin to trigger headaches instead of relieve them. Some people with rebound headaches have near-constant migraines, one melding into the next without relief.

If someone suffers from migraines that last more than four hours at least 15 days per month, we consider them to have chronic daily headaches. Though chronic daily headaches affect a smaller portion of people than migraines – less than five percent of the U.S. population – the condition can be debilitating and damaging to mental health. We can prevent chronic daily headaches by treating migraines before they get worse.    

If medications aren’t helping your migraines, request an appointment with a headache specialist or call 202-877-DOCS.  

Advanced migraine treatments

Migraine treatment falls into two categories: abortive and preventive. Abortive treatments usually are designed to stop migraine symptoms after they start, while preventive treatments aim to reduce the frequency or severity of migraines.  

Typically, we try to treat migraines first with abortive treatment. Any abortive treatments we provide should be taken as soon as you notice migraine symptoms. If severe, frequent and long-lasting migraines persist, we’ll look at preventive treatments.  

My migraine patients have access to a range of abortive and preventive treatments, including:

  • Botox therapy: Botulinum toxin injections are an effective treatment for chronic daily headaches.  
  • External nerve stimulation: An egg-sized device placed on the forehead stimulates the trigeminal nerve, producing a sedative effect that can help reduce the frequency of migraines.
  • Medications: A variety of prescriptions, such as antidepressants, anti-seizure medications and painkillers, can improve migraine symptoms.  
  • Nerve blocks: A medication is injected near the occipital nerve in the back of the head to reduce migraine pain.
  • Surgery:  People with migraines who also have chronic daily headache may benefit from surgery to reduce pressure on certain nerves.  
  • Transcranial magnetic stimulation: A special device held against the back of the head delivers a magnetic pulse to stop migraines as they start.  

With these advanced treatments, we’re able to give many people with severe migraines the relief they’re looking for. And with promising new types of migraine medication on the horizon, people with debilitating migraines soon might have even more options available.