Related Experiment Video
Updated: Jul 18, 2026
07:01
Electrophoretic Delivery of γ-aminobutyric Acid (GABA) into Epileptic Focus Prevents Seizures in Mice
Published on: May 16, 2019
Prescribing antiepileptics for the elderly: differences between guideline recommendations and clinical practice
Mary Jo V Pugh1, Perry J Foreman, Dan R Berlowitz
1South Texas Veterans Healthcare System, San Antonio, Texas, USA. pughm@uthscsa.edu
Drugs & Aging
|November 18, 2006
Summary
Older adults with epilepsy need careful antiepileptic drug (AED) selection. Despite guidelines, suboptimal drugs like phenobarbital remain common, indicating slow adoption of best practices in elderly epilepsy treatment.
Area of Science:
- Geriatric Medicine
- Neurology
- Pharmacology
Background:
- Epilepsy incidence is highest in individuals over 60.
- Treatment for older epilepsy patients was historically based on younger patient data.
- Growing evidence highlights unique considerations for antiepileptic drug (AED) selection in the elderly.
Purpose of the Study:
- To review guidelines and recommendations for AED use in elderly patients.
- To assess the adoption of these recommendations in clinical practice.
- To explore reasons for delays in adopting evidence-based prescribing for elderly epilepsy patients.
Main Methods:
- Systematic review of published guidelines and clinical recommendations for AEDs in the elderly.
- Analysis of studies on recent AED prescribing patterns in older adults.
- Application of diffusion of innovations theory to understand adoption delays.
Main Results:
- One guideline suggested lamotrigine due to its favorable side effect profile for the elderly.
- Expert opinion recommendations explicitly identified appropriate and inappropriate AEDs for older adults.
- Prescribing patterns show slow adoption of clinical recommendations, with phenobarbital still used despite being identified as suboptimal since 1985.
Conclusions:
- Continued use of suboptimal AEDs like phenobarbital in newly diagnosed elderly epilepsy patients signifies a significant delay in guideline adoption.
- Barriers to appropriate prescribing may include lack of clinician knowledge, insufficient opinion leaders, focus on seizure control, and entrenched prescribing habits.
- Further research is needed to identify strategies for improving AED prescribing practices in the elderly population.
Related Concept Videos
01:15Drug Dosing: Geriatric Patients
Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
01:00Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are not...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
01:22Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...