J Korean Epilepsy Soc.
2008 Dec;12(2):67-77.
Use of Antiepileptic Drugs in the Elderly
- Affiliations
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- 1Department of Neurology and Gyeongsang Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea. oykwon@nongae.gsnu.ac.kr
Abstract
- The incidence of epilepsies and seizures is higher in the age group over 65-year-old than any other age group. The reduction of the dosages of antiepileptic drugs is recommended and the therapeutic effects can be expected even in the low dosage in the elderly. Because the daily activity is impaired and the health state is not good usually in the elderly, they are sensitive to the side effects of antiepileptic drugs. When using antiepileptic drugs in the elderly, the careful observation of possible side effects is essential. The elderly epileptic patients may have several concomitant diseases and it lead to have polypharmacy. The polypharmacy increase the risk of drug interactions. The dosage should be adjusted individually and the using drugs which are not necessary should be avoided. The clinical information about the use of antiepileptic drugs in the elderly is quite limited. In the elderly of the nursing home in the USA, phenytoin was the most frequently prescribed antiepileptic drug. However phenytoin is not the safest and most comfortable antiepileptic drug in the elderly. Generally, many aspects of the elderly including health state, concomitant diseases, concomitant medications, drug-interactions, side effects, and cost-effectiveness should be considered when choosing antiepileptic drugs in the elderly. The dosage of the selected antiepileptic drugs should be adjusted according to the clearance rate. The monitoring of the serum drug concentration may be helpful.
