title: Treatment of epilepsy in 3 specialized populations.
abstract: When discussing the treatment of epilepsy, targeted populations need to be defined. Three patient groups, children, the elderly, and women, are considered "special" because of metabolic and physical differences that require particular care during treatment of this disease. Treatment options vary significantly among these populations. Metabolic differences in very young and elderly patients require close attention by the prescribing physician. Rates of metabolism in children may be much faster than in nonelderly adults, requiring dosing adjustments to ensure enough medication is used to control seizures. Additional concerns with treating children include their increased sensitivity to toxic effects. Elderly patients may have slower metabolic rates because of decreased renal or hepatic function, and thus these patients can easily be overdosed as toxic drug levels build when clearance is reduced. Many elderly patients also may have concomitant illnesses that require other chronic medications. The potential for drug interactions is very high among this population. Women are considered a special population because of issues related to contraception, childbirth, and breast-feeding. Some antiepileptic medications are known to reduce the efficacy of oral contraceptives, and no medication has been proven safe for pregnant women. The pharmacokinetic profiles of many new generation antiepileptic medications may be advantageous to these specialized populations by creating fewer adverse effects, cleaner metabolism, and the reduced risk for drug interactions and teratogenicity.
authors.forename: I E
authors.initials: IE
authors.lastname: Leppik
mesh_terms: D000367:Age Factors; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000145:classification / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002220:Carbamazepine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002648:Child; D004347:Drug Interactions; D004827:Epilepsy / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D010672:Phenytoin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D019338:Polypharmacy; D011247:Pregnancy; D013723:Teratogens; D014635:Valproic Acid / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D013723:Teratogens; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin