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Related Experiment Videos

Seizures and epilepsy in the elderly

R J Thomas1

  • 1Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, USA.

Archives of Internal Medicine
|March 24, 1997
PubMed
Summary

Elderly seizures and epilepsy present unique challenges, with causes including stroke and Alzheimer's. New antiepileptic drugs offer safer options, but some older medications should be avoided in older adults.

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Area of Science:

  • Geriatric Medicine
  • Neurology
  • Clinical Pharmacology

Background:

  • Seizures and epilepsy are a growing concern in the elderly population.
  • Common causes include cerebrovascular disease, brain tumors, degenerative disorders (e.g., Alzheimer's disease), and toxic-metabolic syndromes.
  • Diagnosis can be challenging due to atypical presentations and differential diagnoses, such as nonconvulsive status epilepticus mimicking confusion.

Purpose of the Study:

  • To review the causes, diagnostic challenges, and treatment of seizures and epilepsy in the elderly.
  • To discuss the implications of age-related physiological changes on pharmacokinetics and pharmacodynamics.
  • To evaluate the safety and efficacy of newer antiepileptic drugs (AEDs) in this demographic.

Main Methods:

  • Literature review of studies on epilepsy and seizures in older adults.
  • Analysis of age-related factors influencing drug metabolism and interactions.
  • Comparison of traditional and novel AEDs for geriatric use.

Main Results:

  • Electroencephalogram (EEG) utility is limited but can aid in first seizure evaluation.
  • Convulsive status epilepticus, particularly drug-induced, carries high mortality in the elderly.
  • Newer AEDs like oxcarbazepine and gabapentin may have better safety profiles; vigabatrin has minimal cognitive effects.
  • Lamotrigine and felbamate may offer neuroprotective benefits in ischemic cerebrovascular disease.

Conclusions:

  • Treatment of epilepsy in the elderly requires careful consideration of drug interactions and age-related changes.
  • Certain medications (barbiturates, primidone, clobazam, flunarizine, cinnarizine) should be avoided.
  • Newer AEDs present promising alternatives for managing seizures in older adults.

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