Treatment recommendations for anticonvulsant drug therapy in the older patient

Seizures in older individuals are frequently due to cerebrovascular disease, though other causes, such as primary or metastic brain tumour, must be considered. Recurrence after a first seizure may be as high as 83% by 3 years, suggesting that withholding an anticonvulsant after a first seizure may not be wise. Some older patients may be more sensitive to anticonvulsant side effects, so treatment with 1 drug is encouraged, with monitoring of blood concentrations of the anticonvulsant during initiation of therapy. Interaction of anticonvulsants with other drugs is less of a problem than may be expected, but should be kept in mind. The treatment of status epilepticus should be aggressive.