Neurology Book

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Epilepsy in the Elderly

Aka: Epilepsy in the Elderly, Seizure Disorder in the Elderly
  1. See Also
    1. Seizure
    2. Single Seizure Evaluation
    3. Status Epilepticus
  2. Epidemiology
    1. Incidence of Seizure disorder increases after age 60
      1. Incidence: 100 Seizures per 100,000 over 60 in U.S.
  3. Causes: Acute Symptomatic Seizures (onset after age 60)
    1. See Seizure Causes
    2. Cerebrovascular Accident (32%)
    3. Idiopathic: No identifiable cause (25%)
    4. Brain Tumor: Meningioma, glioma, metastases (14%)
    5. Head Trauma with Subdural Hematoma
    6. CNS Infection (Meningitis, Encephalitis)
    7. Alzheimer's Dementia
    8. Metabolic disturbance
      1. Hypoglycemia or Hyperglycemia
      2. Hyponatremia
      3. Uremia
      4. Alcohol Withdrawal
    9. References
      1. Luhdorf (1986) Epilepsia 27:458-63 [PubMed]
  4. Causes: Status Epilepticus (at onset, and over age 60)
    1. Cerebrovascular Accident (most common)
    2. Head Trauma
    3. Other causes
      1. Hypoxia
      2. Hyperglycemia
      3. Brain Tumor: Meningioma, glioma, metastases
      4. CNS Infection (Meningitis, Encephalitis)
      5. Drug Intoxication or withdrawal
    4. References
      1. Sung (1989) Acta Neurol Scand 80:51-6 [PubMed]
  5. Evaluation and Initial Management
    1. See Seizure Evaluation
    2. See Seizure Emergency Management (Status Epilepticus)
  6. Management
    1. Determine if Seizure Prophylaxis needed
      1. Many elderly patients will not have recurrence
      2. Consider differential diagnosis
        1. See Seizure Causes
        2. See above causes
      3. Indications
        1. Recurrent Seizures
        2. Status Epilepticus history
        3. CNS Lesion
    2. Medication selection criteria
      1. Lower cost
      2. Conveniently dosed (qd to bid)
      3. Fewer adverse effects
      4. Lower Drug Interaction risk (and low protein binding)
    3. Medication options (start low and go slow)
      1. Older medications (lower cost)
        1. Phenytoin (Dilantin)
        2. Valproic Acid (Depakote)
        3. Carbamazepine (Tegretol)
      2. Newer medications (less interactions, side effects)
        1. Oxcarbazepine (Trileptal)
        2. Gabapentin (Neurontin)
        3. Lamotrigine (Lamictal)
  7. References
    1. Lackner (2002) Pharmacotherapy 22:329-64 [PubMed]
    2. Stephen (2000) Lancet 355:1441-6 [PubMed]
    3. Velez (2003) Am Fam Physician 67(2):325-32 [PubMed]

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