Review of topiramate for the treatment of epilepsy in elderly patients

Abstract

Individuals over 65 years of age experience the new onset of seizures at a prevalence rate of roughly twice that of younger adults. Differences in physiology, need of concomitant medications, and liability for cognitive deficits in this population, make the choice of anticonvulsant drugs especially important. This paper reviews topiramate (TPM), a treatment for many types of seizures, with the above risks in mind. In particular, we discuss efficacy and pharmacokinetics with emphasis on the older patient, and adverse events in both the younger and older adult. With most studies of TPM-induced cognitive deficits having been performed in younger adults and volunteers, we discuss the implications for the older adult. Even in studies of younger individuals, up to 50% discontinue TPM because of intolerable cognitive deficits. Most studies find specific declines in working memory and verbal fluency. In conclusion, we give recommendations for use of this antiepileptic drug in this population.

How do you choose the appropriate migraine pharmacotherapy for an elderly person?

“…Nevertheless, among TCAs, amytriptiline, and nortryptiline dose adjustment is not indicated even with a glomerular filtration rate lower than 15 mL/min [7]. Conversely, topiramate dose should be lowered in older adults even with normal creatinine levels (half of the dose should be prescribed with creatinine clearance < 70 ml/min/1.73 m 2 ), whereas agerelated changes in hepatic function alone did not result in significant clinical impact or the need for dose adjustments [8]. Atenolol and metoclopramide doses must be lowered with low creatinine clearance according to the drug monographs, while ketorolac should be avoided in patients with renal impairment.…”

Treatment of epilepsy in patients with Alzheimer’s disease

“…In a recent review, inconclusive data were reported concerning the efficacy and tolerability of zonisamide (ZNS) in the treatment of elderly patients with epilepsy, mainly concerning cognitive side effects 42 . Few data are reported about topiramate (TPM) use in elderly, but they suggest that, despite a generally good efficacy and tolerability profile, it seems to be a second choice in treatment of epilepsy in these patients due to both its cognitive and psychiatric AEs 43,44 .…”

Kopfschmerzen im Alter: Was ist anders?

“…Wesentliche spezifisch altersbedingte Einschränkungen für die Verordnung von Valproinsäure und Topiramat gibt es nicht, es liegen relativ umfangreiche Erfahrungen bei älteren Patienten aus der Epilepsietherapie vor [9]. Generell ist die Verträglichkeit von Amitriptylin im Alter wegen der anticholinergen Wirkung schlechter als bei Jüngeren.…”