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Optimizing antiepileptic drug therapy in the elderly.
1Medical College of Virginia, Virginia Commonwealth University, PO Box 980533, Richmond, VA 23298-0533, USA. wrgarnett@hsc.vcu.edu
The Annals of Pharmacotherapy
|September 29, 2005
Summary
Selecting antiepileptic drugs (AEDs) for elderly patients requires careful consideration of age-related pharmacokinetic and pharmacodynamic changes. Maximizing drug tolerability is key for effective seizure management in this population.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacology
- Neurology
Background:
- Elderly individuals exhibit the highest incidence of seizures, with complex partial and generalized tonic-clonic seizures being most common.
- Diagnosing epilepsy in the elderly can be challenging due to low suspicion and conditions mimicking seizures.
Purpose of the Study:
- To review and evaluate the medical literature on antiepileptic drug (AED) therapy in elderly patients.
- To identify key considerations for selecting and managing AEDs in geriatric populations.
Main Methods:
- Comprehensive MEDLINE and internet searches were conducted for relevant literature from 1982 to December 2004.
- Bibliographies of identified articles were reviewed to ensure thoroughness.
- Clinical studies and review articles were evaluated for inclusion.
Main Results:
- Most AEDs are approved for partial and tonic-clonic seizures in the elderly.
- Age-related pharmacokinetic and pharmacodynamic variations necessitate individualized AED selection.
- Potential drug-drug interactions are a significant concern due to polypharmacy in the elderly.
- Tolerability is a critical determinant in choosing AEDs for older adults.
Conclusions:
- AED selection in the elderly hinges on maximizing drug tolerability.
- Cognitive function and sensitivity to lower AED concentrations require special attention.
- A multifactorial approach is essential for optimizing antiepileptic treatment in geriatric patients.