Treating epilepsy in the elderly - Safety considerations

The incidence of epilepsy increases with advancing age. Epilepsy in the eld erly has different aetiologies from that in younger populations, cerebrovas cular disease being the most common condition associated with seizures. Par tial seizures are the predominant seizure type in older patients. A diagnos is of epilepsy in the elderly is based mainly on the history and is frequen tly delayed. In addition, seizure imitators are especially frequent. In man y cases ancillary tests for diagnosis may show normal age-related variants, sometimes making results difficult to interpret. Treating epilepsy in the elderly is problematic due to a number of issues that relate to age and com orbidity. The physical changes associated with increasing age frequently le ad to changes in the pharmacokinetics of many anticonvulsants. The treatmen t of epilepsy in the elderly is also complicated by the existence of other diseases that might affect the metabolism or excretion of anticonvulsants a nd the presence of concomitant medications that might interact with them. M oreover, specific trials of anticonvulsants in the aged population are scar ce. General guidelines for treatment include starting at lower doses, slowi ng the titration schedule, individualising the choice or anticonvulsant to the characteristics of the patient, avoiding anticonvulsants with important cognitive or sedative adverse effects, and where possible, treating with m onotherapy.