[Anticonvulsant treatment in old age--principles and differential indications]

When administering anticonvulsive drugs to the elderly, a number of peculiarities should be taken into consideration. Age-related changes in pharmacokinetics and drug interactions can make such treatment a complicated issue. Some of the side effects which hardly play a role among younger patients can lead to fatal consequences among the elderly. Both phenytoin (PHT), if submitted intravenously (but not in oral form), and carbamazepine (CBZ) may cause life-threatening cardiac arrhythmias. Valproate (VPA), otherwise well tolerated, seems to be less effective than CBZ and PHT in partial seizures. Cognitive dysfunction is a known side effect of barbiturates, but also seems to occur among the other drugs of first choice. In contrast to a widely held opinion, VPA, CBZ and PHT hardly differ in their effect on cognitive function if administered correctly.