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Treating Epilepsy in the Elderly

Safety Considerations

  • Practical Drug Safety
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Abstract

The incidence of epilepsy increases with advancing age. Epilepsy in the elderly has different aetiologies from that in younger populations, cerebrovascular disease being the most common condition associated with seizures. Partial seizures are the predominant seizure type in older patients. A diagnosis of epilepsy in the elderly is based mainly on the history and is frequently delayed. In addition, seizure imitators are especially frequent. In many cases ancillary tests for diagnosis may show normal age-related variants, sometimes making results difficult to interpret. Treating epilepsy in the elderly is problematic due to a number of issues that relate to age and comorbidity. The physical changes associated with increasing age frequently lead to changes in the pharmacokinetics of many anticonvulsants. The treatment of epilepsy in the elderly is also complicated by the existence of other diseases that might affect the metabolism or excretion of anticonvulsants and the presence of concomitant medications that might interact with them. Moreover, specific trials of anticonvulsants in the aged population are scarce. General guidelines for treatment include starting at lower doses, slowing the titration schedule, individualising the choice of anticonvulsant to the characteristics of the patient, avoiding anticonvulsants with important cognitive or sedative adverse effects, and where possible, treating with monotherapy.

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Acknowledgements

Both Dr Arroyo and Dr Kramer have received travel or research grants, cunsultancy fees or have been on the speakers panels of the major pharmaceutical companies that produce anticonvulsants Novatis, Parke Davis/Pfizer, Desitin, Glaxo-Wellcome (now Glaxo Smith Kline), Aventis/Hoechst Marion Rousell, Jansen-Cilag, Novo Nordisk, Sanofi-Synthelabo and UCB.

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  1. Epilepsy Unit, Hospital Clínico de Barcelona, Villarroel 170, 08036, Barcelona, Spain

    Santiago Arroyo

  2. Swiss Epilepsy Center, Zürich, Switzerland

    Günter Kramer

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Arroyo, S., Kramer, G. Treating Epilepsy in the Elderly. Drug-Safety 24, 991–1015 (2001). https://doi.org/10.2165/00002018-200124130-00006

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