Seizure emergencies in older adults

Seizure emergencies in older adults increase in frequency with increasing age. The reason for this increase in incidence is thought to be secondary to increasing rates of cerebrovascular and neurodegenerative disease in the aging population. Making the correct diagnosis of seizures in older adults can be difficult owing to the neurologic and non-neurologic mimickers of seizures (most notably cardiac) as well as the more frequent atypical presentation of seizures in this age group. Status epilepticus is a life-threatening emergency with a high mortality rate. Initial treatment should include benzodiazepine use followed by fosphenytion or phenytoin. After this, medical management for refractory cases has not been well established. Special considerations for the treatment of status epilepticus and epilepsy in the older adult need to be taken into account owing to the high prevalence of other medical comorbidities.