Epilepsy in the elderly

The incidence of epilepsy is high in the elderly. Increasing awareness of t his phenomenon has led to a better understanding of the predominant seizure types, their clinical manifestations, and the most appropriate treatment r egimens. Carbamazepine, phenytoin, and valproic acid are considered to be f irst-line antiepileptic drugs (AEDs). However, the newer AEDs gabapentin, l amotrigine, and tiagabine also warrant consideration as first-line agents b ecause of their efficacy and favorable side-effect profiles. This is partic ularly important because aging produces physical changes in the patient tha t can increase the likelihood of adverse effects. To select the appropriate drug and dosage for each individual, a variety of issues must be considere d. These include age-related changes in body composition and physiology, as well as the pharmacokinetics, routes of administration, drug interactions, adverse-effect profiles, and cost of available agents.