Peculiarity of epilepsy in elderly people: a review

Incidence of epilepsy in elderly patients is higher than in any other group. The diagnosis of epilepsy in old age is particularly challenging and is often overlooked or missed. Selection of appropriate antiepileptic drugs (AEDs) for this group of patient also requires more attention than younger patients.

To summarise the clinical presentation, aetiology, diagnosis, treatment, and neuropsychiatric complications of epilepsy in old age.

Systematic review of existing literature on epilepsy in the elderly was carried out using original articles, review articles, meta-analysis, case reports, standard neurology text and the Cochrane library data.

Stroke and neurodegenerative disorders account for most causes of epilepsy in older patients. Simple partial and complex seizures are common modes of clinical manifestation. Post-ictal confusion and memory lapses are particularly prolonged in the elderly. The presence of other co-morbidities, age-related changes in pharmacokinetics and possible risk of drug-drug interaction needs to be considered before commencement of medication. Older AEDs like phenobarbitone and phenytoin should be avoided in the elderly because of their pharmacological profiles. Although newer AEDs have better tolerability, there is no evidence that they are advantageous over the older ones in terms of seizure control and should be used as add-on pills. The older AEDs have the advantages of being cheaper and being readily available in developing countries.

The goal of epilepsy management in the elderly goes beyond attainment of seizure control but should include improvement in quality of life. AEDs should be introduced cautiously based on patient's frailty and starting with lower dosage.