Elderly patients with systemic disease.

Although the healthy elderly seizure patient can often be treated with antiepileptic drugs (AEDs) similarly to a younger counterpart, the elderly with systemic disease require a more complex approach. The interplay of multiple organ dysfunctions and multiple non-AED medications greatly increases the challenges of managing the majority of older epilepsy patients. In addition, age-related physiologic changes in hepatic and renal function, volume of distribution, and exaggerated sensitivity to side effects alter the usual "rules" for administering AEDs. Thorough knowledge of the general principles of geriatric physiology and pharmacology may predict optimal selection of initial or subsequent AED therapy in this population.