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


METHODS
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.


METHODS
Clinical studies and reviews were evaluated, and relevant information was included.


RESULTS
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.
Garnett
William R
WR
Medical College of Virginia, Virginia Commonwealth University, PO Box 980533, Richmond, VA 23298-0533, USA. wrgarnett@hsc.vcu.edu
D000927:Anticonvulsants / Q000378:metabolism / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D016903:Drug Monitoring / Q000379:methods; D006801:Humans; D012640:Seizures / Q000188:drug therapy*
D000927:Anticonvulsants; D003577:Cytochrome P-450 Enzyme System