IEC 2025 | Psychiatric comorbidities of late-onset epilepsy: the hidden iceberg

I think there are two main points to this. First of all, they’re hidden because there’s been so little research about them. It’s quite incredible to think that most trials of clinical medications have excluded people who are older. And this is despite the fact that the prevalence of epilepsy becomes twice as much in people over the age of 75. So this is a group of people who do have epilepsy at higher rates even, but they’ve been excluded from research studies to a very large extent. And the second factor is that the way that the presentations are may be very different. And we make a lot of assumptions. First of all there’s been an assumption that dissociative seizures don’t occur in older people, that they occur mainly in young women. And in fact, so we really don’t know much about the incidence and how much of an issue this is. And secondly, as I mentioned before, the presentations may be different, with much more biological emphasis. There may be cultural differences in the way that people present, there may be a stigma in having not only epilepsy but having some psychiatric problems as well. So for multiple reasons, these problems have been hidden, little researched. There’s little information about the best treatments. And it’s an area that I’m so pleased that the International League Against Epilepsy is shining a light on because it’s something that we can do a lot about. These comorbidities can be treated. They make a very big difference to quality of life and to the epilepsy as well. So we know that treating these comorbidities helps with adherence, and we know also that treating the epilepsy helps with these comorbidities. So there’s a bidirectional relationship and opportunity to intervene.

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