Management of epilepsy in the elderly.

Epilepsy in elderly patients is a growing worldwide challenge; as the population ages, the prevalence of epilepsy increases. Management of epilepsy in elderly patients requires an understanding of their unique medical and pharmacologic characteristics. Accurate assessment of seizures, thorough neurologic assessment to define etiology, and evaluation of concomitant illnesses and living situations are necessary for comprehensive treatment planning and informed management. Expect elderly patients to present challenges to treatment that include concomitant diseases, obligatory polypharmacy with accompanying drug interactions, and age-related changes in renal and hepatic physiology that alter drug metabolism and elimination. Elderly patients have declining intellectual function, motor impairment, or altered special sensory function that make them susceptible to dose-related CNS side effects of antiepileptic drugs (AEDs). When AEDs are added to the medical regimen of an elderly patient, the physician must review all prescribed drugs. Drugs prescribed for concomitant illnesses such as behavioral problems, cardiovascular disease, hypertension, and infection may alter the distribution and metabolism of AEDs, with an impact on efficacy and occurrence of adverse effects. AEDs tend to induce metabolism of other drugs, leading to a decline in target response. Optimal care of elderly patients with epilepsy includes use of free levels to monitor AED concentrations, careful dose selection, and physician sensitivity to patients' social problems.