Drug Safety

, Volume 24, Issue 13, pp 991–1015

Treating Epilepsy in the Elderly

Safety Considerations
  • Santiago Arroyo
  • Günter Kramer
Practical Drug Safety

DOI: 10.2165/00002018-200124130-00006

Cite this article as:
Arroyo, S. & Kramer, G. Drug-Safety (2001) 24: 991. doi:10.2165/00002018-200124130-00006


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.

Copyright information

© Adis Data Information BV 2001

Authors and Affiliations

  • Santiago Arroyo
    • 1
  • Günter Kramer
    • 2
  1. 1.Epilepsy Unit, Hospital Clínico de BarcelonaBarcelonaSpain
  2. 2.Swiss Epilepsy CenterZürichSwitzerland

Personalised recommendations