[Anti-epilepsy drugs and their use in the elderly]

RISING INCIDENCE AND PREVALENCE: The frequency of epilepsy after the age of 60 years is increasing, a particularly important point in light of the rise in this age group. Incidence is estimated to exceed 100 cases per 100,000 subjects over the age of 60, reaching 160 per 100,000 in subjects aged 80 to 84 years. Prevalence exceeds 7 per 1000 in the 55 to 64 age group and 12 per 1000 in the 85 to 94 age group. CLINICAL FEATURES IN THE ELDERLY: Partial complex seizures are particularly frequent. Some patients experience seizure-related confusion states or slowly regressive neurological deficits.

Excepting acute seizures induced by aggressive cerebral events, treatment should be aimed at the triggering factor. Anti-epilepsy drugs are warranted in patients who experience 2 or more seizures and for whom no amendable triggering factor can be identified. For stroke patients, long-term treatment should be reexamined after the acute phase. DRUG PRESCRIPTION: Benzodiazepines have proven efficacy when the objective is to achieve rapid control of frequent seizures. However, for elderly subjects, the risk of sedation and known adverse effects must be carefully assessed for these drugs. All anti-epilepsy agents are active: choosing the right drug for elderly subjects depends basically on patient tolerance and risk of drug interaction. Special attention should be given to the effect on cognitive function.