MANAGEMENT OF EPILEPSY IN THE ELDERLY

Epilepsy in elderly patients is a growing worldwide challenge; as the population ages, the prevalence of epilepsy increases. Management of e pilepsy in elderly patients requires an understanding of their unique medical and pharmacologic characteristics. Accurate assessment of seiz ures, thorough neurologic assessment to define etiology, and evaluatio n of concomitant illnesses and living situations are necessary for com prehensive treatment planning and informed management. Expect elderly patients to present challenges to treatment that include concomitant d iseases, obligatory polypharmacy with accompanying drug interactions, and age-related changes in renal and hepatic physiology that alter dru g metabolism and elimination. Elderly patients have declining intellec tual function, motor impairment, or altered special sensory function t hat make them susceptible to dose-related CNS side effects of antiepil eptic drugs (AEDs). When AEDs are added to the medical regimen of an e lderly patient, the physician must review all prescribed drugs. Drugs prescribed for concomitant illnesses such as behavioral problems, card iovascular disease, hypertension, and infection may alter the distribu tion and metabolism of AEDs, with an impact on efficacy and occurrence of adverse effects. AEDs tend to induce metabolism of other drugs, le ading to a decline in target response. Optimal care of elderly patient s with epilepsy includes use of free levels to monitor AED concentrati ons, careful dose selection, and physician sensitivity to patients' so cial problems.