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GERIATRICS

Optimizing Antiepileptic Drug Therapy in the Elderly

Professor of Pharmacy and Neurology, Medical College of Virginia, Virginia Commonwealth University, PO Box 980533, Richmond, VA 23298-0533, fax 804/828-8328, wrgarnett{at}hsc.vcu.edu

Reprints: Dr. Garnett

OBJECTIVE: To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients.

DATA SOURCES: A MEDLINE search (1982-December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references.

STUDY SELECTION AND DATA EXTRACTION: Clinical studies and reviews were evaluated, and relevant information was included.

DATA SYNTHESIS: The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic-clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic-clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug-drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability.

CONCLUSIONS: Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients' cognitive functioning and their tendency to respond to lower AED concentrations.

Key Words: antiepileptic drugs, elderly

Published Online, September 27, 2005. www.theannals.com, DOI 10.1345/aph.1E683

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-032-H01