Epilepsy is often thought of as a condition that begins in childhood — but the reality is quite different. In Ireland and across the developed world, the highest rate of new epilepsy diagnoses occurs in people over the age of 60. If you or someone you care about has recently been diagnosed with epilepsy later in life, you are far from alone, and there is excellent support available.
At Críonna Health, we believe that understanding a condition is the first step towards living well with it. This guide covers what late-onset epilepsy looks like, what causes it, and — most importantly — the practical steps you can take in Ireland today.
TL;DR
- Late-onset epilepsy (diagnosed after 50) is the most common new neurological diagnosis in older adults — you are not alone
- Seizures in older adults often look different from the dramatic convulsions most people imagine: brief confusion, staring spells, or memory gaps are more typical
- Common causes include stroke, head injury, neurodegenerative conditions, and brain tumours — but in up to half of cases, no cause is found
- Most people respond well to anti-seizure medication, though dosing needs careful attention due to age-related changes and polypharmacy
- Epilepsy Ireland offers free support, and the HSE’s Chronic Disease Management Programme covers ongoing GP-led care at no extra charge
- Driving regulations in Ireland require you to be seizure-free for one year before driving — the NDLS and your neurologist can guide you through the process
What Is Late-Onset Epilepsy?
Epilepsy is a neurological condition characterised by a tendency to have recurrent seizures. When it first appears after the age of 50, it is sometimes called late-onset or elderly-onset epilepsy — though at Críonna Health, we prefer the term “late-onset” as a more respectful description.
According to data from Epilepsy Ireland and international research, the incidence of epilepsy rises sharply after 60 and peaks in people over 75. The Irish Longitudinal Study on Ageing (TILDA) has highlighted the growing number of older adults managing neurological conditions, making awareness and early intervention more important than ever.
Why Seizures Look Different After 50
One of the biggest challenges with late-onset epilepsy is that seizures often do not look the way most people expect. The dramatic tonic-clonic (“grand mal”) seizure — falling to the ground, limbs jerking — does occur, but it is not the most common presentation in older adults.
Instead, seizures in people over 50 frequently present as:
- Focal aware seizures: unusual sensations such as a rising feeling in the stomach, déjà vu, tingling, or a sudden odd taste or smell — you remain conscious throughout
- Focal impaired awareness seizures: brief episodes of confusion, staring, lip-smacking, fumbling with clothes, or automatic repetitive movements — you may have no memory of the event afterwards
- Post-ictal confusion: prolonged confusion or drowsiness after a seizure, which can last hours or even days in older adults
These subtler presentations are frequently mistaken for dementia, transient ischaemic attacks (TIAs or “mini-strokes”), medication side effects, or simply “having a funny turn.” This means diagnosis can be delayed — sometimes by months or years.
What to do: If you or someone you know is experiencing unexplained episodes of confusion, blank staring, memory gaps, or unusual sensations, speak with your GP. A referral to a neurologist and an EEG (electroencephalogram) can help clarify the diagnosis.
Common Causes in Older Adults
Late-onset epilepsy can have identifiable causes, though in many cases no specific trigger is found. The most common causes include:
- Cerebrovascular disease: stroke is the single most common cause of new-onset epilepsy after 50, accounting for roughly 30–40% of cases. Even “silent” strokes that went unnoticed can leave scar tissue that triggers seizures later
- Neurodegenerative conditions: Alzheimer’s disease and other dementias increase seizure risk, particularly in later stages
- Brain tumours: both primary tumours and secondary (metastatic) cancers can cause seizures
- Head injury: even a head injury sustained years earlier can increase risk
- Metabolic or toxic causes: kidney disease, liver problems, low sodium, alcohol withdrawal, or certain medications can lower the seizure threshold
- Idiopathic (unknown): in 30–50% of older adults with new epilepsy, no specific cause is identified despite thorough investigation
Your neurologist will typically arrange brain imaging (an MRI) and blood tests to look for underlying causes.
Treatment: What Works and What to Watch For
The good news is that late-onset epilepsy generally responds well to treatment. Most people achieve good seizure control with a single anti-seizure medication (ASM) at a relatively low dose.
However, prescribing for older adults requires particular care:
- Polypharmacy: many people over 50 are already taking medications for blood pressure, cholesterol, diabetes, or blood thinning. Some ASMs interact significantly with these — for example, older drugs like carbamazepine and phenytoin can reduce the effectiveness of warfarin and certain cardiac medications
- Liver and kidney changes: age-related changes in how the body processes drugs mean that lower starting doses are usually recommended
- Bone health: some older ASMs (phenytoin, carbamazepine, sodium valproate) are associated with reduced bone density — important in a population already at risk of osteoporosis. Talk with your GP about vitamin D supplementation and bone density monitoring
- Newer medications: levetiracetam and lamotrigine are often preferred for older adults because they have fewer drug interactions, are better tolerated, and do not affect bone density as significantly
Never stop or change your seizure medication without medical guidance. Sudden withdrawal can trigger dangerous seizures, including status epilepticus (a prolonged seizure that requires emergency treatment).
Driving and Epilepsy in Ireland
A new epilepsy diagnosis has significant implications for driving. Under the Road Safety Authority (RSA) guidelines and the National Driver Licence Service (NDLS) regulations:
- You must be seizure-free for one year before you can hold or regain a Group 1 (car) driving licence
- For Group 2 (truck/bus) licences, the seizure-free period is ten years without medication
- You are legally required to inform the NDLS and your motor insurer of your diagnosis
- Your neurologist will provide a medical report to support your licence application when the time comes
Losing driving independence can be deeply frustrating, particularly in rural Ireland where public transport is limited. The Free Travel Pass (available to those with certain medical conditions, not just over 66s) may help. Local Link rural transport services and community car schemes can also fill the gap — contact your local Citizens Information Centre for options in your area.
Living Well With Epilepsy After 50
Beyond medication, there is a great deal you can do to manage your condition and reduce seizure risk:
- Prioritise sleep: sleep deprivation is one of the most common seizure triggers at any age. Aim for a consistent sleep routine
- Manage stress: stress and anxiety can lower the seizure threshold. Mindfulness, gentle exercise, and social connection all help
- Limit alcohol: alcohol can interact with ASMs and independently trigger seizures. If you drink, keep within low-risk guidelines and discuss limits with your neurologist
- Keep a seizure diary: recording when seizures happen, what you were doing, sleep patterns, and any possible triggers helps your medical team fine-tune treatment. Epilepsy Ireland offers a free seizure diary app
- Review medications regularly: ask your GP or pharmacist for an annual medication review, particularly if you are taking multiple medications
- Stay active: regular physical activity is safe and beneficial for most people with epilepsy. Walking, swimming (with a companion), gardening, and chair-based exercises are all excellent options
- Tell someone: make sure family, friends, or housemates know what to do if you have a seizure — Epilepsy Ireland provides free seizure first-aid training
Safety at Home
A few practical adjustments can reduce the risk of injury:
- Use a shower rather than a bath (or use a very shallow bath with a non-slip mat)
- Avoid cooking over an open flame — use a microwave or induction hob where possible
- Ensure smoke alarms are fitted and working
- Consider a personal alarm (such as those provided by ALONE or Pobal-funded schemes) if you live alone
- Keep bedroom furniture padded or positioned away from the bed if you have seizures during sleep
Irish Supports and Resources
Ireland has strong supports for people living with epilepsy:
- Epilepsy Ireland: the national organisation providing information, support groups, advocacy, and a free helpline (01 455 7500). They run regional community resource officers who can visit you at home
- HSE Chronic Disease Management (CDM) Programme: if you have a medical card or GP visit card, your GP can provide structured ongoing epilepsy care — including regular reviews and medication management — at no extra charge under the CDM Programme
- Neurology services: HSE neurology clinics operate in all major hospitals. Waiting times can be long, so ask your GP about urgent referral pathways if needed
- Long-Term Illness Scheme: epilepsy is covered under the HSE’s Long-Term Illness (LTI) Scheme, which means your anti-seizure medications and related supplies are provided free of charge regardless of income
- Medical card: if your diagnosis affects your ability to work, you may qualify for a medical card on hardship grounds — apply through your local HSE office
- Citizens Information: for help navigating entitlements, driving regulations, and social welfare supports
When to Seek Emergency Help
Most seizures end on their own within a few minutes. However, call 999 or 112 if:
- A seizure lasts longer than five minutes
- The person does not regain consciousness between seizures
- It is the person’s first seizure
- The person is injured, has difficulty breathing, or the seizure happens in water
- You are unsure — it is always better to call
A Word From Críonna Health
A diagnosis of epilepsy after 50 can feel daunting — but with the right medication, support, and practical adjustments, most people continue to live full, active, and independent lives. Understanding your condition, staying connected with your healthcare team, and making use of the excellent supports available in Ireland are the foundations of living well.
If you have been recently diagnosed, reach out to Epilepsy Ireland — their team understands exactly what you are going through, and their support is free, confidential, and available nationwide.
📷 Photo by Sven Mieke on Unsplash
