BACKGROUND: Incidence of epilepsy in elderly patients is
higher than in any other group. The diagnosis of epilepsy in old
age is particularly challenging and is often overlooked or
missed. Selection of appropriate antiepileptic drugs (AEDs) for
this group of patient also requires more attention than younger
patients.
OBJECTIVE: To summarise the clinical presentation, aetiology,
diagnosis, treatment, and neuropsychiatric complications of
epilepsy in old age.
METHODS: Systematic review of existing literature on epilepsy
in the elderly was carried out using original articles, review
articles, meta-analysis, case reports, standard neurology text
and the Cochrane library data.
RESULTS: Stroke and neurodegenerative disorders account for
most causes of epilepsy in older patients. Simple partial and
complex seizures are common modes of clinical manifestation.
Post-ictal confusion and memory lapses are particularly
prolonged in the elderly. The presence of other co-morbidities,
age-related changes in pharmacokinetics and possible risk of
drug-drug interaction needs to be considered before
commencement of medication. OlderAEDs like phenobarbitone
and phenytoin should be avoided in the elderly because of their
pharmacological profiles. Although newerAEDs have better
tolerability, there is no evidence that they are advantageous
over the older ones in terms of seizure control and should be
used as add-on pills. The olderAEDs have the advantages of
being cheaper and being readily available in developing
countries.
CONCLUSION: The goal of epilepsy management in the elderly
goes beyond attainment of seizure control but should include
improvement in quality of life. AEDs should be introduced
cautiously based on patient’s frailty and starting with lower
dosage.