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The number of people aged 60 or over is rapidly
increasing. Demographers estimate that 20% of the world’s population
will be aged 60 or over by the year 2050. The incidence of newly
diagnosed epilepsy in adults over the age of 60 years, generally
referred to as late onset epilepsy, is second only to that of children,
who are the most frequently diagnosed group. In fact, seizures in
general, and epilepsy in particular, are among the most common
neurological disorders of the elderly (Hauser, 1992). There exists a
broad range of factors that predispose older adults to developing
seizures and epilepsy. Vascular conditions, infections of the central
nervous system and head trauma all have relative or absolute peaks in
incidence in late adulthood (Hauser, 1992). Additionally, epilepsy is
frequently a long-term complication of progressive disorders such as
Alzheimer’s Disease. Despite these identified causative factors, the
single largest group, accounting for more that 40% of newly diagnosed
cases of epilepsy in the elderly, is classified as idiopathic, that is,
of unknown origin.
Seizures are only part of the burden of epilepsy,
and for some individuals, are not even the major part. Missed
educational, occupational and social opportunities may cause great
distress. Public misperceptions about epilepsy, the stigma that is still
attached to seizures and the widespread fear of seizures, contribute to
social disability. Epilepsy is associated with a variety of social
consequences that may be especially severe in older adults (Coffey &
Cumming, 1994). A person’s ability to effectively relate to others is
critical to positive social adjustment. Comfort in social situations,
the ability to meet and interact with others and the existence of a
supportive social network are all-important aspects of social
adjustment. However, older adults are subject to a number of conditions
that may jeopardise social interactions. Firstly, low self-esteem,
particularly arising from the increased dependency that this disorder
engenders (Dodrill & Batzill, 1986) may be especially pertinent for
older individuals who may already be reliant on family and others.
Secondly, the unpredictable nature of epilepsy with the risk of a
seizure at any time may cause feelings of loss of control. The potential
for a seizure in public can be particularly distressing and for older
adults, may be even more frightening because of their very real
vulnerability to severe physical injury in the event of a seizure
related fall.
Epilepsy is also associated with an increased risk
of psychiatric illness, particularly depression. The relationship
between epilepsy and depression has been recognised since the time of
Hippocrates, who observed a relatively high frequency of
"melancholia" among those with epilepsy, as well as asserting
that "melancholics were prone to develop epilepsy" (Lewis,
1934). Depression is, in fact, the main reason for the psychiatric
hospitalisation of people with epilepsy (Betts, 1981). In spite of
contrary studies (Dodrill & Batzill, 1986) most investigations which
have examined the relationship between depression and epilepsy report a
twofold greater frequency of depression among seizure patients than
among comparable individuals (Kogeorgos, Fonagy & Scott, 1982). This
would suggest that depression which is co-morbid with epilepsy may
involve an organic mood disorder either alone or combined with a
psychosocial reaction to the unique characteristics of epilepsy, such as
the unpredictable nature of seizures and the concomitant feelings of
loss of control engendered in the person with epilepsy. There may also
be other variables associated specifically with epilepsy that influence
the nature of co-morbid depression. Unfortunately, researchers have
focussed almost exclusively on younger people in these studies and very
little is known about the impact of depression on older adults with
epilepsy, especially where the epilepsy is of recent diagnosis.
In order to address this gap, researchers from the
University of Queensland are conducting a study on epilepsy in late
adulthood and are seeking people over the age of 55 years who have
epilepsy to participate. In addition, we are also interested in talking
to people over the age of 55, who have both epilepsy and depression.
Participation involves meeting a researcher either at your home, or at
the University of Queensland Psychology Clinic, and the completion of a
few questionnaires, along with a discussion about how your epilepsy has
affected your life. If you are interested, please contact Dee
McLaughlin at Epilepsy Queensland on 3435 5000 or 1300 852 853 (outside
Brisbane).
References
Betts, T.A. (1981). Depression, anxiety and
epilepsy. In Epilepsy and Psychiatry, Reynolds, E. & Trimble,
M.R. (Eds.) pp175-184.
Coffey, C.E. & Cummings, J.L. (1994). The
American Psychiatric Press textbook of geriatric neuropsychiatry.
Dodrill, C.B. & Batzel, L.W. (1986). Interictal
behavioral features of patients with epilepsy. Epilepsia, 27 (Suppl
2). S64-S76.
Hauser, W.A. (1992). Seizure disorders: The changes
with age. Epilepsia, (Suppl 3) S6-S14.
Kogeorgos, J., Fonagy, P & Scott, D.F. (1982).
Psychiatric symptom patterns of chronic epileptics attending a
neurological clinic: a controlled investigation. British Journal of
Psychiatry, 140. 236-243.
Lewis, A.J., (1934). Melancholia: A historical
review. Journal of Mental Science, 80. 1-42
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