In older adults, a first seizure is often provoked by something treatable: hyponatraemia, hypoglycaemia, alcohol or benzodiazepine withdrawal, a drug that lowers the seizure threshold, infection or a new stroke. Syncope and transient ischaemic attack are common mimics.
Check glucose, sodium, calcium and kidney function, review the medication list, and arrange MRI. When choosing an antiseizure drug for an older patient, consider interactions and falls risk alongside efficacy.
- Check glucose, sodium, calcium and renal function in every older adult with a first seizure
- Review medications that lower the seizure threshold, such as tramadol and some antidepressants
- Consider syncope, transient ischaemic attack and transient global amnesia as mimics
- Arrange MRI rather than CT alone where available
- Consider drug interactions and falls risk when choosing an antiseizure medicine
Why it matters
A treatable metabolic or drug cause is easy to miss once the label of epilepsy is applied.
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