Strategies for Optimizing Antiepileptic Drug Therapy in Elderly People

Abstract

The elderly take more antiepileptic drugs (AEDs) than all other adults. This extensive use directly correlates with an increased prevalence of epilepsy in a growing population of older people, as well as other neuropsychiatric conditions such as neuropathic pain and behavioral disorders associated with dementia and for which AEDs are administered. The agents account for nearly 10% of all adverse drug reactions in the elderly and are the fourth leading cause of adverse drug reactions in nursing home residents. Numerous factors associated with advanced age contribute to the high frequency of untoward drug effects in this population; however, strategies are available to ensure optimal outcomes.

Benzodiazepines for prolonged seizures

“…In spite of its long elimination half-life, diazepam appears to have a short duration of anticonvulsant effect of about 15–30 min,22 with a risk of recurrence of seizures in about 50% of patients 23. This is probably related to its rapid redistribution as a result of its high lipophilicity.…”

Clinical practice

“…However, it is the duration of the actual anticonvulsant effect that determines the clinical efficacy of different benzodiazepines. The anticonvulsant effect of diazepam lasts for 15-30 min, while lorazepam works for between 24 and 48 h [25]. Midazolam also has a short duration of action (and a short elimination half-life) [37], as illustrated in the study by Hayashi et al [37] in Japan.…”

Management of epilepsy in elderly

“…19,25,27 Since the elderly is predisposed to problems associated with polypharmacy e.g., non-adherence, drug interactions, AED monotherapy is preferred and often can provide a good seizure control. 28 In the elderly, the pharmacokinetic change and affect drug handling and the relationship between dose and serum level can be very different compare to that of younger adults. For many drugs, age is an important variable in a wide range of pharmacokinetic parameters.…”

“…29 Many patients requiring therapy for prolonged period of time tend not to take their medications as prescribed. 28 Patient with a chronic disease, that does not cause pain or other unusual discomfort such as epilepsy or hypertension, may easily neglect to take their medicine. The end result of such noncompliance is exacerbation of the existing disorder in the future.…”