Epilepsy in the elderly

Elderly persons with epilepsy are expected to be an increasing group among patients with epilepsy in view of population aging and the higher onset of epilepsy in the elderly as compared to any other age group. Cerebrovascular disease is the most common cause of seizures in the elderly, and complex partial seizures (CPS) are the most common seizure type in this age group. CPS semiology is often different in the elderly compared to young adults, since strokes usually involve extratemporal regions. The absence of familiar clinical characteristics of seizures, such as aura and automatisms, can delay the correct diagnosis of epilepsy or lead to misdiagnosis. As a result of age-related pharmacokinetic changes, the clearance of most old and new antiepileptic drugs (AEDs) is reduced by 20-40% in elderly persons compared to younger adults, and there may be a longer elimination half-life of certain AEDs. In addition to measurements of serum AED concentration, it is important to monitor clinical response, since age-related pharmacodynamic changes can alter the relationship between serum AED concentration and pharmacological effects. Newer AEDs have a lower potential for drug interactions and are better tolerated by the elderly compared to old generation AEDs. Monotherapy is the preferred therapeutic strategy for initial treatment of seizures due to fewer adverse events, decreased risk of drug interactions, improved adherence and lower treatment costs. Elderly patients with epilepsy are more likely to remain seizure-free on AED treatment than younger age groups. Elderly patients with refractory epilepsy and precise localization of the seizure focus can be appropriate surgical candidates, and a favorable prognosis is expected with curative surgical procedures.