Multimorbidity and epilepsia in the elderly

Epilepsia is a frequent disease in the elderly. Most of the time seizures are the consequence of another or other comorbidities and they are generally partial. Causal pathologies are either cerebral or general. The most common is the stroke, especially if it is haemorrhagic. If the seizure is delayed in relation to stroke, it defines vascular epilepsy and is an indication for long-term antiepileptic therapy. Neurodegenerative diseases, primarily Alzheimer's disease, are associated with epilepsy, but the pathophysiological links between the two are poorly understood. The clinical presentation of seizures is often atypical and the existence of memory disorders complicates the diagnosis because they make it difficult to reconstruct the anamnesis. Cranial trauma and tumours are the other classic brain causes of epilepsy. The general causes include metabolic and hydroelectrolytic disorders (especially hypoglycaemia and hyponatremia), drugs (either by their toxicity or by a withdrawal syndrome), and uraemic encephalopathy of renal failure. Finally, alcohol is a common cause not to be neglected, including among institutionalised patients.