Selection of Antiepileptic Drugs in Older People

Batool F. Kirmani, Diana Mungall Robinson, Adeline Kikam, Ekokobe Fonkem, Daniel Cruz

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug–drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug–drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.

Original languageEnglish (US)
Article number295
Pages (from-to)1-16
Number of pages16
JournalCurrent Treatment Options in Neurology
Volume16
Issue number6
DOIs
StatePublished - Jun 1 2014
Externally publishedYes

Fingerprint

Anticonvulsants
Pharmacokinetics
Age Groups
Comorbidity
Epilepsy
Population
Enzyme Induction
Incidence
Protein Binding
Pharmaceutical Preparations
Half-Life
Seizures
Stroke
Costs and Cost Analysis
Therapeutics

Keywords

  • AED
  • Anticonvulsants
  • Antiepileptic drugs
  • Carbamazepine
  • Elderly
  • Epilepsy
  • Epilepsy surgery
  • Gabapentin
  • Gabapentin
  • Lamotrigine
  • Levetiracetam
  • Pharmacokinetics
  • Phenobarbital
  • Phenytoin
  • Stroke
  • Vagus nerve stimulator implant
  • Valproic acid

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Selection of Antiepileptic Drugs in Older People. / Kirmani, Batool F.; Robinson, Diana Mungall; Kikam, Adeline; Fonkem, Ekokobe; Cruz, Daniel.

In: Current Treatment Options in Neurology, Vol. 16, No. 6, 295, 01.06.2014, p. 1-16.

Research output: Contribution to journalReview article

Kirmani, Batool F. ; Robinson, Diana Mungall ; Kikam, Adeline ; Fonkem, Ekokobe ; Cruz, Daniel. / Selection of Antiepileptic Drugs in Older People. In: Current Treatment Options in Neurology. 2014 ; Vol. 16, No. 6. pp. 1-16.
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