Advances in antiepileptic drug treatments. A rational basis for selecting drugs for older patients with epilepsy.
Incidence of epilepsy increases rapidly after age 65; recent studies indicate that approximately 10% of nursing home residents are being treated with antiepileptic drugs (AEDs). Almost all are being treated with first generation AEDs. The average nursing home patient receives six medications, has age-related changes in protein binding, decreases in hepatic and renal clearance, and may have alterations in gastrointestinal absorption. AEDs that do not have drug-drug interactions, are not metabolized by the liver, and are readily absorbed may offer benefits in this population. New studies are demonstrating that the first generation AEDs have a number of shortcomings for treating older patients, whereas some of the newer AEDs may overcome these limitations. This paper reviews the present knowledge base and compares properties of the first generation AEDs with newer agents to develop a more rational approach for drug selection in older adults.
Leppik
Ilo E
IE
University of Minnesota, Minneapolis, USA.
Bergey
Gregory K
GK
Ramsay
R Eugene
RE
Rowan
A J
AJ
Gidal
Barry E
BE
Birnbaum
Angela K
AK
Elliott
Mary Beth
MB
D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy*; D015577:Geriatric Assessment; D006801:Humans
D000927:Anticonvulsants