Treatment of Epilepsy in the Elderly

The treatment of epilepsy in older individuals is an increasingly important topic in neurology and an area that all treating neurologists should have familiarity with. As the population ages, the number of patients over 65 who present with new-onset epilepsy will increase, as will the complexity of their comorbid medical and neurological disorders. In older patients, seizures are often unwitnessed, or present with atypical symptoms, making the diagnosis more challenging. Additionally, there are relatively limited data to guide the use of anti-epileptic medications and other treatments in this patient population. Elderly patients may experience increased side effects from anti-epileptic drugs compared with younger patients and in general, are likely to have a narrower therapeutic window and greater degree of individual variation with respect to side effects. Familiarity with anti-epileptic medication dosing and titration schedules, possible adverse effects, and potential pharmacokinetic and drug interactions can be helpful when considering treatment options and may increase the likelihood of success.