title: [Epilepsy in the elderly].
abstract: BACKGROUND
  Diagnostic work-up and treatment of patients who have developed epilepsy after the age of 65 can both be difficult. Epilepsy is one of the most common neurological conditions in the elderly, and the incidence of de novo geriatric epilepsy is rising. The aim of this review is to provide guidance on the management of epilepsy in this patient group.
  
  
  METHODS
  The review is based on a discretionary selection of original articles and reviews found in PubMed using the search term combination 'epilepsy' and 'elderly', and the authors' personal experience.
  
  
  RESULTS
  The seizures, which are most commonly of the focal type, are not infrequently overlooked or misdiagnosed. Cerebrovascular disease is the underlying cause of about half of the cases. When selecting an anticonvulsant, it is important to take age-related physiological changes and comorbidities into consideration. Because elderly patients have a narrower therapeutic window than younger persons and greater susceptibility to cognitive and other side effects, a low starting dose and slower dose titration are particularly important.
  
  
  CONCLUSIONS
  The results of studies of young epilepsy patients cannot be extrapolated to apply to elderly patients. More studies directly targeting this patient population are therefore needed. As a general rule, we do not recommend starting on enzyme-inducing drugs such as phenytoin, phenobarbital and carbamazepine, partly because of their high interaction potential.
authors: Avdeling for kompleks epilepsi - SSE, Klinikk for kirurgi og nevrofag, Oslo universitetssykehus, Norway. karl.otto.nakken@ous-hf.no
authors: Karl O
authors: KO
authors: Nakken
authors: Erik
authors: E
authors: Sætre
authors: Rune
authors: R
authors: Markhus
authors: Morten I
authors: MI
authors: Lossius
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging / Q000378:metabolism; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004827:Epilepsy / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007555:Isoxazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000077213:Lamotrigine; D000077287:Levetiracetam; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D011788:Quality of Life; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D014227:Triazines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000078305:Zonisamide
chemical_list: D000927:Anticonvulsants; D007555:Isoxazoles; D014227:Triazines; D000077287:Levetiracetam; D000078305:Zonisamide; D000077213:Lamotrigine; D010889:Piracetam