title: Selection of antiepileptic drugs in older people.
abstract: Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug-drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug-drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.
authors.affiliation: Epilepsy Center, Department of Neurology, Scott and White Neuroscience Institute, Temple, TX, USA, bkirmani@sw.org.
authors.forename: Batool F
authors.initials: BF
authors.lastname: Kirmani
authors.forename: Diana Mungall
authors.initials: DM
authors.lastname: Robinson
authors.forename: Adeline
authors.initials: A
authors.lastname: Kikam
authors.forename: Ekokobe
authors.initials: E
authors.lastname: Fonkem
authors.forename: Daniel
authors.initials: D
authors.lastname: Cruz
references.citation: Neuropsychobiology. 1998 Oct;38(3):185-91
references.pmid: 9778607
references.citation: Eur J Pharmacol. 2002 Aug 9;449(3):221-28
references.pmid: 12167463
references.citation: J Clin Pharmacol. 1998 Feb;38(2):166-71
references.pmid: 9549648
references.citation: BMJ. 2005 Dec 3;331(7528):1317-22
references.pmid: 16322020
references.citation: Epilepsia. 1995 Apr;36(4):327-33
references.pmid: 7607110
references.citation: Seizure. 1996 Dec;5(4):267-70
references.pmid: 8952011
references.citation: Neurology. 1994 Apr;44(4):601-8
references.pmid: 8164811
references.citation: Clin Neuropharmacol. 2007 Jul-Aug;30(4):189-95
references.pmid: 17762314
references.citation: Ther Adv Musculoskelet Dis. 2011 Oct;3(5):235-43
references.pmid: 22870482
references.citation: Epilepsia. 2009 Sep;50(9):2140-6
references.pmid: 19486359
references.citation: Epilepsia. 1993 Mar-Apr;34(2):312-22
references.pmid: 8453943
references.citation: Neurology. 1992 Mar;42(3 Pt 1):662-5
references.pmid: 1549233
references.citation: Acta Neurol Scand. 1984 Aug;70(2):77-80
references.pmid: 6485747
references.citation: Neurology. 2000 Aug 22;55(4):588-91
references.pmid: 10953201
references.citation: Geriatrics. 2004 Dec;59(12):14-8, 22-4
references.pmid: 15667018
references.citation: West Afr J Med. 2010 Nov-Dec;29(6):365-72
references.pmid: 21465442
references.citation: Neurology. 2008 Sep 2;71(10):723-30
references.pmid: 18765648
references.citation: Epilepsia. 2008 Feb;49(2):316-9
references.pmid: 17919301
references.citation: Geriatrics. 2005 Nov;60(11):42-7
references.pmid: 16287341
references.citation: Epilepsia. 1999 Dec;40(12):1721-6
references.pmid: 10612335
references.citation: Epilepsia. 2000 Mar;41(3):342-51
references.pmid: 10714408
references.citation: Epilepsia. 2004 May;45(5):410-23
references.pmid: 15101822
references.citation: Lancet Neurol. 2009 Nov;8(11):1019-30
references.pmid: 19800848
references.citation: Epilepsia. 2002 Dec;43(12):1488-92
references.pmid: 12460249
references.citation: J Anal Toxicol. 2006 Oct;30(8):599-602
references.pmid: 17132258
references.citation: Epilepsia. 2008;49 Suppl 1:45-9
references.pmid: 18184155
references.citation: Ann Neurol. 1990 Mar;27(3):232-7
references.pmid: 2327734
references.citation: Seizure. 2011 May;20(4):305-11
references.pmid: 21257324
references.citation: Drug Saf. 2001;24(13):991-1015
references.pmid: 11735655
references.citation: Epilepsia. 2001 Jun;42(6):764-71
references.pmid: 11422333
references.citation: Epilepsia. 2007 Jul;48(7):1292-302
references.pmid: 17561956
references.citation: Clin Interv Aging. 2010 Apr 26;5:89-99
references.pmid: 20458347
references.citation: Cleve Clin J Med. 2005 Oct;72 Suppl 3:S26-37
references.pmid: 16265941
references.citation: Epileptic Disord. 2005 Jun;7(2):91-5
references.pmid: 15929910
references.citation: Acta Neurol Scand. 2005 Nov;112(5):277-86
references.pmid: 16218908
references.citation: Discov Med. 2010 Feb;9(45):138-44
references.pmid: 20193640
references.citation: Neurology. 2005 Jun 14;64(11):1868-73
references.pmid: 15955935
references.citation: Epilepsia. 1995;36 Suppl 2:S2-12
references.pmid: 8784210
references.citation: Epilepsy Res. 1999 Oct;37(1):81-7
references.pmid: 10515178
references.citation: Epilepsy Res. 1998 Jan;29(2):161-6
references.pmid: 9477149
references.citation: Neurology. 2001 Mar 27;56(6):743-8
references.pmid: 11274308
references.citation: Lancet Neurol. 2011 May;10(5):446-56
references.pmid: 21511198
references.citation: Neurology. 2000 Jun 13;54(11):2166-70
references.pmid: 10851387
references.citation: Epilepsia. 1970 Dec;11(4):361-81
references.pmid: 5278205
references.citation: Pharmacopsychiatry. 2006 Jan;39(1):9-12
references.pmid: 16453247
references.citation: Seizure. 2011 Sep;20(7):554-7
references.pmid: 21531583
references.citation: Neurology. 2000 Mar 14;54(5):1179-82
references.pmid: 10720294
references.citation: Neurology. 2000;55(5 Suppl 1):S9-14; discussion S54-8
references.pmid: 11001357
references.citation: Epilepsy Behav. 2001 Oct;2(5):460-465
references.pmid: 12609284
references.citation: Neurology. 2006 May 9;66(9):1318-24
references.pmid: 16682661
references.citation: Seizure. 2008 Mar;17(2):181-6
references.pmid: 18187347
references.citation: Epilepsia. 2004 Nov;45(11):1330-7
references.pmid: 15509233
references.citation: Epilepsia. 2001;42 Suppl 3:55-9
references.pmid: 11520326
references.citation: Cochrane Database Syst Rev. 2002;(3):CD001908
references.pmid: 12137637
references.citation: J Neurol Neurosurg Psychiatry. 1997 Apr;62(4):372-6
references.pmid: 9120451
references.citation: Neurology. 1999 Nov 10;53(8):1731-5
references.pmid: 10563620
references.citation: P T. 2010 Jul;35(7):392-415
references.pmid: 20689626
references.citation: Lancet. 1995 Feb 25;345(8948):476-9
references.pmid: 7710545
references.citation: Neurology. 2008 Apr 29;70(18):1586-93
references.pmid: 18443309
references.citation: Epilepsia. 2008 Dec;49(12):2092-9
references.pmid: 18479399
references.citation: Epilepsia. 2006 Mar;47(3):510-5
references.pmid: 16529614
references.citation: Epilepsy Res. 2008 Feb;78(2-3):140-6
references.pmid: 18155445
references.citation: Semin Neurol. 2008 Jul;28(3):305-16
references.pmid: 18777477
references.citation: J Neurophysiol. 2011 Sep;106(3):1227-39
references.pmid: 21653714
references.citation: J Am Pharm Assoc (Wash). 2001 May-Jun;41(3):421-36
references.pmid: 11372907
references.citation: Drugs Aging. 1995 Jul;7(1):38-48
references.pmid: 7579780