EPILEPSY IN THE ELDERLY

Epilepsy ist the third most common neurological disease of the elderly . In the elderly the incidence is higher than in childhood and adolesc ence. Cerebrovascular diseases are in 50% of the cases the most common cause for a seizure beyond the age of sixty. The importance of neopla sias is often overestimated. The risk for a renewed seizure after a fi rst seizure is higher in the senium than in youth. Furthermore, the in cidence of seizure-related injuries is increased in the elderly and th erefore, anticonvulsive therapy must be started early with guaranteed compliance. With regard to therapy, the altered pharmacokinetics in se nium must be considered. The drug of first choice is carbamazepine. If a monotherapy with carbamazepine, phenytoin or valproate does not con trol the seizures a combination with one of the new antiepileptic drug s must be initiated. Due to their pharmacokinetic characteristics, the new drugs - such as vigabatrin, gabapentin and lamotrigine - are spec ially suitable in the therapy of elderly patients. in case of undesira ble side effects, monotherapy with one of the new anticonvulsants ough t to be considered.