Reflections on the treatment of seizures in the elderly population

Treatment of seizure disorders in older patients is an important problem because of the age-related increase in seizure incidence and the growing size of this segment of the population. Physiologic changes that occur with aging may influence drug dosing and safety. The standard antiepileptic drugs (AEDs) are not ideal for treating older patients because of their complex pharmacokinetics, multiple drug interactions, and possible increased susceptibility to adverse effects. Data are limited on the use of the newer AEDs--gabapentin, lamotrigine, topiramate, and tiagabine--in older patients. An ongoing clinical trial in this population is investigating the efficacy and safety of gabapentin and lamotrigine relative to carbamazepine for the treatment of new-onset partial seizures. Other trials are needed to evaluate the use of topiramate and tiagabine in older patients with epilepsy. In the absence of these data, AED selection in older patients must be made on the basis of current knowledge of efficacy and safety profiles. The newer agents now offer increased therapeutic options and some theoretical advantages over the older AEDs for elderly persons with seizures.