Epilepsy in older adults. Common morbidities influence development, treatment strategies, and expected outcomes

Given that that the average person has one chronic illness for each decade over age 50, one would expect that patients who develop seizures in late life would have associated medical and/or neurologic conditions. Cerebrovascular disease, hypertension, heart disease, diabetes mellitus, renal disease, and dementia all relate to epilepsy. Co-morbidities not only contribute to the causation and consequences of seizures, they also interfere with effective treatment and optimal functioning. Because seizures in older individuals can lead to serious consequences, safe and effective treatment is essential. Yet, antiepileptic drugs (AEDs) may cause adverse effects that may be worse in older patients when compared to younger patients. Multiple medications lead to a high probability that medically significant drug interactions may occur and must be monitored for in geriatric patients.