Skip to main content

Advertisement

SpringerLink
Log in

Treatment of epilepsy in the elderly

  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

The elderly are the most rapidly growing segment of the population, and the incidence of epilepsy in persons over 65 is higher than in any other age group. In nursing homes, its incidence is even higher than in community-dwelling persons of similar ages. About 10% of nursing home residents are being treated with antiepileptic drugs (AEDs), with an “epilepsy/seizure” indication reported for about 7.7% of this use. Almost all elderly patients are being treated with AEDs introduced before 1978—phenytoin, carbamazepine, valproate, and barbiturates. However, age-related changes in protein binding, decreases in hepatic and renal clearance, alterations in gastrointestinal absorption, and interactions with drugs used for other conditions make the choice of the best AED difficult. AEDs that do not interact with other drugs, are not metabolized by the liver, and are readily absorbed may offer benefits for the elderly. To complicate matters, the elderly are not a homogeneous population. Today there are many AEDs to choose from, and some of the newer AEDs have more favorable characteristics than the older ones. Choice of an AED should be made on an individual basis, considering the cost of the drug, the cost of consequences of drug-drug interactions, and expenses associated with acute and chronic adverse effects. In other words, clinical skills rather than formulaic approaches are needed to match detailed knowledge of each patient’s characteristics with the properties of the various AEDs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Cloyd JC, Lackner TE, Leppik IE: Antiepileptics in the elderly. Pharmacoepidemiology and pharmacokinetics. Arch Fam Med 1994, 3:589–598.

    Article  PubMed  CAS  Google Scholar 

  2. Lackner TE, Cloyd JC, Thomas LW, et al.: Antiepileptic drug use in nursing home residents: effect of age, gender, and comedication on patterns of use. Epilepsia 1998, 39:1083–1087.

    Article  PubMed  CAS  Google Scholar 

  3. Garrard J, Harms S, Hardie N, et al.: Antiepileptic drug use in nursing home admissions. Ann Neurol 2003, 54:75–85.

    Article  PubMed  Google Scholar 

  4. Birnbaum A, Hardie NA, Leppik IE, et al.: Variability of total phenytoin serum concentrations within elderly nursing home residents. Neurology 2003, 60:555–559.

    PubMed  CAS  Google Scholar 

  5. Rowan AJ, Ramsay RE, Collins JF, et al.: New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology 2005, 64:1868–1873.

    Article  PubMed  CAS  Google Scholar 

  6. Morrell MJ, Leppik I, French J, et al.: The KEEPER trial: levetiracetam adjunctive treatment of partial-onset seizures in an open-label community-based study. Epilepsy Res 2003, 54:153–161.

    Article  PubMed  CAS  Google Scholar 

  7. Morrell MJ, McLean MJ, Willmore LJ, et al.: Efficacy of gabapentin as adjunctive therapy in a large, multicenter study. The Steps Study Group. Seizure 2000, 9:241–248.

    Article  PubMed  CAS  Google Scholar 

  8. Hauser WA: Seizure disorders: the changes with age. Epilepsia 1992, 33(Suppl 4):S6–S14.

    Article  Google Scholar 

  9. Hauser WA, Annegers JF, Kurland LT: Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia 1993, 34:453–468.

    Article  PubMed  CAS  Google Scholar 

  10. Cloyd JC, Remmel RP: Antiepileptic drug pharmacokinetics and interactions: impact on the treatment of epilepsy. Pharmacotherapy 2000, 20(8 Pt 2):139S–151S.

    Article  PubMed  CAS  Google Scholar 

  11. Firth M, Prather CM: Gastrointestinal motility problems in the elderly patient. Gastroenterology 2002, 122:1688–1700.

    Article  PubMed  Google Scholar 

  12. Brodie MJ, Overstall PW, Giorgi L: Multicentre, doubleblind randomized comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res 1999, 37:81–87.

    Article  PubMed  CAS  Google Scholar 

  13. Welty TE, Gidal BE, Ficker DM, et al.: Levetiracetam: a different approach to the pharmacotherapy of epilepsy. Ann Pharmacother 2002, 36:296–304.

    Article  PubMed  CAS  Google Scholar 

  14. McLean MJ, Gidal BE: Gabapentin dosing in the treatment of epilepsy. Clin Ther 2003, 25:1382–1406.

    Article  PubMed  CAS  Google Scholar 

  15. Werz MA, Lang P, Rienzo T: Levetiracetam therapy for epilepsy: use and tolerability in the elderly [abstract 2.307]. Epilepsia 2003, 44(Suppl 9):280–281.

    Google Scholar 

  16. Hachad H, Ragueneau-Majlessi I, Levy RH: New antiepileptic drugs: review on drug interactions. Ther Drug Monit 2002, 24:91–103.

    Article  PubMed  CAS  Google Scholar 

  17. Vestergaard P, Tigaran S, Rejnmark L, et al.: Fracture risk is increased in epilepsy. Acta Neurol Scand 1999, 99:269–275.

    PubMed  CAS  Google Scholar 

  18. Leppik IE, Wolff D: Drug interactions in the elderly with epilepsy. In Seizures and Epilepsy in the Elderly. Edited by Rowan AJ, Ramsay RE. Boston: Butterworth-Heinemann; 1998: 291–302.

    Google Scholar 

  19. Mattson RH, Cramer J, Collins JF: A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med 1992, 327:765–771.

    PubMed  CAS  Google Scholar 

  20. Cramer J, Leppik IE, DeRue K, et al.: Tolerability of levetiracetam in elderly patients with CNS disorders. Epilepsy Res 2003, 56:135–145.

    Article  PubMed  CAS  Google Scholar 

  21. Sachdeo RC, Wasserstein A, Mesenbrink PJ, et al.: Effects of oxcarbazepine on sodium concentration and water handling. Ann Neurol 2002, 51:613–620.

    Article  PubMed  CAS  Google Scholar 

  22. Martin R, Meador K, Turrentine L, et al.: Comparative cognitive effects of carbamazepine and gabapentin in healthy senior adults. Epilepsia 2001, 42:764–771.

    Article  PubMed  CAS  Google Scholar 

  23. Leppik IE: Introduction to the International Geriatric Epilepsy Symposium (IGES). Epilepsy Res 2006, 68(Suppl 1):1–4.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MINCEP Epilepsy Care, 7500 Western Avenue, Golden Valley, MN, 55427, USA

    Ilo E. Leppik

Authors
  1. Ilo E. Leppik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilo E. Leppik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leppik, I.E. Treatment of epilepsy in the elderly. Curr Treat Options Neurol 10, 239–245 (2008). https://doi.org/10.1007/s11940-008-0026-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11940-008-0026-9

Keywords

Search

Navigation