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Epilepsy in the Elderly

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Epilepsy in the Elderly, Seizure Disorder in the Elderly

  • Epidemiology
  1. Incidence of Seizure disorder increases after age 60
    1. Incidence: 100 Seizures per 100,000 over 60 in U.S.
  • 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]
  • Evaluation and Initial Management
  • 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)