Epilepsy in Aging Populations

Older adults pose special challenges when seizures or epilepsy occur. Increased risk for seizures is often unrecognized. Older adults may have milder epilepsy, and may not require or tolerate standard doses of anti-epileptic drugs (AEDs). Polypharmacy and drug interactions are potential problems, and altered protein binding, hepatic function, renal clearance, and gastric function can affect AED dosing. Side effects such as ataxia, somnolence, and confusion are of heightened concern in this group. Older adults typically suffer localization or focal onset seizures. Although many AEDs treat these types of seizures, the AED chosen for any given patient is determined by concomitant polypharmacy, side effect profile, as well as underlying medical conditions. Free and total AED levels may be necessary. The goal of seizure management for a hospitalized patient may be rapid seizure control. As the individual moves into the outpatient setting, AED therapy without side effects and with appropriate quality of life must be pursued.