New-onset epilepsy in the elderly: diagnosis and treatment

Epilepsy is increasingly becoming a condition newly diagnosed in the elderly. Diagnosis can be difficult when the patient is unable to recall events, there is an absence of eye-witness accounts, and clinical symptoms are significantly more diverse and atypical, with less specific seizure symptomology. There is increased mortality reported in this age group. Therefore, early identification of status epilepticus and non-convulsive status epilepticus essential, along with timely emergency treatment to stop the seizure and improve clinical outcomes. Elderly patients have psychosocial, self-management needs and require a multidisciplinary healthcare service to address their complex needs, numerous comorbidities, medication management and the provision of epilepsy-related information. This article reviews updated national epilepsy guidelines and current literature. It highlights what constitutes good clinical practice in the diagnosis and management of new-onset epilepsy and seizures in the elderly and what special considerations are required by healthcare professionals in selecting first-line anti-seizure medication to enhance quality of life.