Although epilepsy can start at any point during a person’s life, most epilepsy is diagnosed in childhood, and most of all in the first year of life – around 140 out of every 100,000 babies under the age of one are diagnosed with epilepsy per year. This drops to 40 adults per 100,000. However, recent reports have shown that epilepsy is increasing in older people, who account for a quarter of all new diagnoses, according to a survey by the National Society for Epilepsy. The condition is twice as common in older people as it is in the population as a whole.
It may be even more common than is documented, because some of it probably goes unrecognized. Diagnosing epilepsy in the elderly can be difficult. In many cases the seizures are mild, and, while this is excellent news in terms of control, it may also mean that it’s not so easy to spot them for what they are. Aunt Alice’s daydreaming, Gran’s ‘funny turns’, may form part of family folklore and certainly not be seen to warrant medical investigation. We tend to expect illness and absent-mindedness in older people as a matter of course. However, epilepsy in later life may well be among the more preventable cases of the condition. The older we get, the more liable we become to decreased fitness and health, but, in particular, epilepsy in the older person is often due to cerebrovascular disease which leads to small scars in the brain. In general, the risk of epilepsy in older people may be reduced with proper attention to lifestyle, including healthy eating, enough exercise, not smoking, and drinking alcohol moderately. Paying attention to lifestyle issues may help people of any age gain better seizure control and improve general health, and may also prevent your epilepsy getting worse in older age.
Epilepsy is divided almost equally between the sexes, though a few epilepsy syndromes occur exclusively in girls. Epilepsy is slightly more common in men, and there are various reasons why this may be so. One reason is that men are more likely to suffer head injury and brain infection. Another theory is that the brains of boy and girl babies develop differently in the womb due to differences in male and female sex hormones. The brain matures more rapidly in girl babies than boy ones, so that girls are less vulnerable to perinatal anoxia (lack of oxygen around birth) which can damage developing areas of the brain. The Y chromosome which produces maleness in unborn babies also slows development down, so that boys are born around two to three weeks behind in maturity than girls, so making them more vulnerable to injury. This vulnerability persists into adulthood – one study showed that, in women, 50 per cent of the risk of developing epilepsy was past by the time they were 19, but in men, this did not happen until they were 24. This risk is thought to outweigh men’s larger brain size. Another study showed that the brains of men and women only become the same size when they are 100, when they have both shrunk enough to be similar! There is some evidence that the prognosis or outlook is slightly worse in women, and it has been suggested that this is because women’s brains are tougher, a more severe event is needed to precipitate the epilepsy. But, in practice, most of these differences are slight – again, each person with epilepsy represents an individual case, and should be treated as such.
Despite its high prevalence, epilepsy, traditionally the ‘Cinderella’ of the health service, attracts little by way of research money – out of the UK’s annual £2 billion medical research budget only £336,000 is spent on epilepsy, less than £1 per person with epilepsy, and comparing unfavorably with say the £250 per person with muscular dystrophy and £140 per person with multiple sclerosis.
A recent survey of health managers in the UK revealed that only 5 per cent had set service standards for epilepsy. However, this may change as epilepsy achieves greater media coverage and public interest, something which is taking place – over the past few years, according to the National Society for Epilepsy, epilepsy has become an ‘interesting’ subject as genetic research and modem brain-scanning methods reveal more about the condition.