Epilepsy in the elderly

The incidence of epilepsy is high in the elderly. Increasing awareness of this phenomenon has led to a better understanding of the predominant seizure types, their clinical manifestations, and the most appropriate treatment regimens. Carbamazepine, phenytoin, and valproic acid are considered to be first-line antiepileptic drugs (AEDs). However, the newer AEDs gabapentin, lamotrigine, and tiagabine also warrant consideration as first-line agents because of their efficacy and favorable side-effect profiles. This is particularly important because aging produces physical changes in the patient that can increase the likelihood of adverse effects. To select the appropriate drug and dosage for each individual, a variety of issues must be considered. These include age-related changes in body composition and physiology, as well as the pharmacokinetics, routes of administration, drug interactions, adverse-effect profiles, and cost of available agents.