Semiology of epileptic seizures in old age and the differential diagnosis – English Version

Epileptic seizures in people older than 60 years cause problems in the diagnosis and assignment, especially if the diagnosis of epilepsy has not yet been made, i.e. if epilepsy is newly diagnosed after the age of 60 years. The differential diagnosis, especially of transient CNS ischemia, can be difficult, especially when there are infrequent events or the patients live alone. How often false positive or false negative diagnoses occur has not yet been investigated in large collectives, but in smaller collectives it becomes clear that this is frequent, which also corresponds to own experiences. Diagnosis of epileptic seizures can be very complicated with demented people of higher age, for whom the anamnesis cannot easily be used and one is very dependent on an exact description from others. In old age, attacks with falls and large attacks, even during sleep, are problematic because they are life-threatening. Even if the group of people of higher age does not typically suffer from sudden unexpected death in epilepsy (SUDEP), the consequences of severe seizures are often serious. This article specifically deals with the semiology of seizures in people of higher age, and especially with the differential diagnosis. This is also illustrated using many case studies from personal experience.