Management of epilepsy in the elderly

Abstract

Epilepsy among the elderly is a frequently occurring pathology, differing in etiology, clinical presentation and prognosis from those of young people. In addition, beyond a certain age, physiological modifi cations are produced in the metabolism which alter the pharmacokinetics of antiepileptic drugs (AEDs), increasing the risk of pharmacological interactions, already greater in these patients due to the frequency of poly-pharmacy. Furthermore, elderly patients are particularly sensitive to certain secondary effects of AEDs, as for example, cognitive disturbances, osteoporosis or weight increase. Given that the effi cacy of the major AEDs is a priori quite similar, and that the epilepsies occurring in this age-group generally have a good prognosis, the selection of an AED will depend more upon its pharmacokinetics and ability to induce certain secondary effects than on its effi cacy. In this respect, levetiracetam and pregabalin, followed by oxcarbazepine and lamotrigine have the most favorable pharmocokinetical profi le. Moreover, on the whole these drugs have very few cognitive effects, do not induce osteoporosis and, with the exception of pregabalin, do not affect weight, making them the fi rst selection for use in the treatment of epilepsy in the elderly.

Management of epilepsy in older adults: A critical review by the ILAE Task Force on Epilepsy in the elderly

“…Given that studies have found few differences in the ability of the ASMs to control seizures, selection is largely driven by the other factors. Adverse side effects from ASMs negatively impact QoL in older adults and can lead to noncompliance 27 . Studies involving younger adults have shown most ASMs can affect memory, cognition, mood, somnolence, and other issues.…”

“…Adverse side effects from ASMs negatively impact QoL in older adults and can lead to noncompliance. 27 Studies involving younger adults have shown most ASMs can affect memory, cognition, mood, somnolence, and other issues. Older adults would likely experience these ASM-specific effects, but the degree may be different and more severe.…”

Safety of Eslicarbazepine Acetate in Elderly Versus Non-Elderly Patients with Focal Seizures: From Pooled Data of Clinical Studies to 8 Years of Post-Marketing Experience

“…The treatment of elderly patients with epilepsy is particularly challenging, as this age group is rarely represented in the clinical trials that have led to the approval of the different antiseizure medications (ASMs) [1,8]. Treatment is complicated by the presence of physiological changes related to aging, comorbidities, cognitive problems, and concerns regarding drug interactions and medication adherence [7].…”

“…Indeed, these patients have a higher incidence of comorbidities and a higher use of concomitant medications that may result in drug-drug interactions [1,2,[9][10][11], including not only interactions with other drugs but also interactions between different ASMs in a polytherapy regimen [6]. Furthermore, age-related physiological changes such as hepatic and renal impairment affect the pharmacokinetics and pharmacodynamics of ASMs and may affect the nature, incidence, and severity of adverse events (AEs) [3,6,11], making these patients particularly sensitive to certain secondary effects of ASMs, such as, for example, cognitive disturbances, hyponatremia, or osteoporosis [8].…”

Assessment of Anticonvulsant Activities of Petroleum Ether Extract of Anacyclus pyrethrum Roots on Experimental Rats

“…Epidemiologically, epilepsy affects around 70 million people worldwide [2] and has a substantial effect not only on the health/wellbeing of people but also on the economic productivity and burden on health care services [3]. Currently, epilepsy is managed by using many antiepileptic drugs, such as phenytoin, carbamazepine, and phenobarbitone [4]. However, using these drugs is associated with severe side effects that may limit its utilization in epilepsy management [5].…”