[Epilepsy in the aged : Challenges in diagnostics and treatment]

Area of Science:

• Neurology
• Geriatrics
• Pharmacology

Background:

• Epilepsy is the third most common neurological disorder in the elderly, following stroke and dementia.
• The incidence of epilepsy rises with age, particularly in individuals 65 years and older.
• Increasing life expectancy will lead to a greater number of elderly patients with epilepsy.

Purpose of the Study:

• To review the challenges and considerations in managing epilepsy in aged patients.
• To highlight the common causes, diagnostic difficulties, and treatment complexities of epilepsy in the elderly.
• To recommend appropriate antiepileptic drugs (AEDs) for older adults.

Main Methods:

• Literature review focusing on epilepsy in aged populations.
• Analysis of epidemiological data on epilepsy incidence in older adults.
• Evaluation of antiepileptic drug (AED) efficacy, tolerability, and interaction profiles in the elderly.

Main Results:

• Cerebrovascular disease and dementia are the primary causes of new-onset epilepsy in the aged.
• Seizure recognition is frequently delayed in older patients, and status epilepticus is more common, leading to higher mortality and morbidity.
• Antiepileptic drug (AED) selection is complicated by comorbidities and polypharmacy.

Conclusions:

• Levetiracetam and lamotrigine are recommended as first-line AEDs for aged patients due to their low interaction potential and favorable tolerability.
• Careful consideration of comorbidities and polypharmacy is crucial when selecting AEDs for elderly individuals.
• Prompt recognition and management of seizures are essential to improve outcomes in older adults with epilepsy.