Issues when treating epilepsy in the elderly

Single seizures and epilepsy are one of the most commonly encountered neurologic disorders in elderly individuals, arising as a result of complex and often multiple acquired underlying pathologies. Ischemia is by far the most frequent etiology, and is found in up to one-third of these patients, followed by tumors, which are diagnosed in approximately 10% of affected individuals. Thus, a multidisciplinary approach to its diagnosis and management is required. Antiepileptic drug (AED) therapy is the mainstay of treatment for epilepsy in the elderly, but age-specific changes in drug metabolism, increased sensitivity to side effects, and the risk of drug interactions must be considered. Some newer AEDs seem to offer advantages over the older agents in terms of their reduced drug interaction potential (due to lack of enzyme induction), and improved tolerability profiles, which is supported by few recent clinical trials. In order to achieve seizure freedom without causing intolerable side effects, treatment should be initiated with monotherapy at low doses and titrated slowly to within the recommended dose range.