Principles in treatment of epilepsy in elderly
Keywords:
AED, drug-drug interactions, epilepsy, elderly, pharmacokinetic changesAbstract
Treating epilepsy in elderly carries higher risk than in younger patients. The choice of antiepileptic treatment requires consideration of factors unique to the elderly including lower dosing, pharmacokinetic changes, treatment response, co-morbidities and interactions with other medications. Differences in pharmacokinetics include changes in gastrointestinal and renal systems, decreased plasma protein binding, decreased hepatic function, decreased renal drug clearance, and prolonged elimination half-life. Adding to this complexity is unpredictable variances between individuals due to pharmacogenomic factors in metabolism, transporters, and receptors. Most of the elderly have comorbidities and that increases the probability of drugdrug interactions. Elderly patients have lowest tolerability to antiepileptic drugs, which requires treatment with lowest doses.
References
Bozhinova, V., Belopitova, L., Ĭotova, R., Dimova, P., Bozhilova, R. Lamictal - terapevtichen spektŭr i podobryavane na lechenieto na det·skite epilepsii. Pediatriya, 2002; 4; 39-43.
Kuzmanova R. Nezhelani lekarstveni efekti pri priem na antiepileptichni lekarstva i kachestvo na zhivot na patsienti s epilepsiya. Dvigatelni narusheniya, 2014; 11, 2, 5-12.
Milanov, I., Chipilski, L., Kolev, P. Depakine-chrono v profilaktikata na migrenata. Tsefalgiya, 1999; 1, 2, 13-15.
Natsionalen konsensus za diagnostika i lechenie na epilepsiyata. Bŭlgarska nevrologiya, 2017; 18, 2.
Acharya, J.N., Acharya, V.J. Epilepsy in the elderly: Special considerations and challenges. Ann Indian Acad Neurol 2014;17, Suppl S1:18-26.
Acosta, I., Vale, F., Tatum, W.O., Benbadis, S.R. Epilepsy surgery after age 60. Epilepsy Behav, 2008; 12:324–325.
Baulac, M. Rational conversion from antiepileptic polytherapy to monotherapy. Epileptic Disorders, 2003;5:25-132.
Berg, A.T., Berkovic, S.F., Brodie, M.J., Buchhalter, J., Cross, J.H., et al. Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia, 2010; 51, 4, 676–685.
Bergey, G.K. Initial treatment of epilepsy: Special issues in treating the elderly. Neurology, 2004; 63, 10, 402–408.
Brodie, M.J., Perucca, E., Ryvlin, P., Ben-Menachem, E., Meencke, H.J. Levetiracetam Monotherapy Study Group. Comparison of levetiracetam and controlled-release carbamazepine in newly diagnosed epilepsy. Neurology, 2007; 68(6):402-408.
Brodie, M.J., Kwan P. Epilepsy in elderly people. BMJ, 2005; 331(7528):1317–1322.
De Lacerda, G.C.B. Treating seizures in renal and hepatic failure. J Epilepsy Clin Neurophysiol, 2008; 14:46–50.
DeLorey, T.M., Olsen, R.W. Gamma-aminobutyric acidA receptor structure and function. J Biol Chem, 1992; 267:16747–16750.
Ferrendelli, J.A., French, J., Leppik, I., Morrell, M.J., Herbeuval, A., Han, J., et al. Use of levetiracetam in a population of patients aged 65 years and older: a subset analysis of the KEEPER trial. Epilepsy Behav, 2003; 4:702-709.
Gates, J.R. Side effect profiles and behavioral consequences of antiepileptic medications. Epilepsy Behav, 2000; 1(3):153-159Harms,
S.L., Eberly, L.E., Garrard, J.M., Hardie, N.A., Bland, P.C., Leppik, I.E. Prevalence of appropriate and problematic antiepileptic combination therapy in older people in the nursing home. JAGS, 2005; 53:1023-1028.
ILAE Commission on Antiepileptic Drugs. Considerations on designing clinical trials to evaluate the place of new antiepileptic drugs in the treatment of newly diagnosed and chronic patients with epilepsy. Epilepsia, 1998; 39:799-803.
Karceski, S., Morrell, M.J., Carpenter, D. Treatment of epilepsy in adults: expert opinion. Epilepsy Behav, 2005; 7:S1-S64.
Kwan P, Brodie MJ. Effectiveness of the first antiepileptic drug. Epilepsia, 2001; 4:1255-1260.
Kwan P, Brodie, M.J. Epilepsy after the first drug fails: substitution or add-on? Seizure 2000; 9:464-468.
Lacerda, G., Krummel, T., Sabourdy, C. et al. Optimizing therapy of seizures in patients with renal or hepatic dysfunction. Neurology, 2006; 67:28–33.
LaRoche, S.M., Helmers, S.L. The new antiepileptic drugs: scientific review. J Am Med Assoc, 2004; 291:605–614.
Loring, D.W., Meador, K.J. Neuropsychological and behavioral effects of antiepilepsy drugs. Neuropsychol Rev, 2007; 17:413-425.
Louis St., E.K., Gidal, B.E., Henry, T.R., Kaydanova, Y., Krumholz, A., at al. Conversions between monotherapies in epilepsy: expert consensus. Epilepsy Behav, 2007; 11:222-234.
Macdonald, R.L., Kelly, K.M. Antiepileptic drug mechanisms of action. Epilepsia, 1995; 36(2):2–12.
Mamiya, K., Yukawa, E., Matsumoto, T., Aita, C., Goto, S. Synergistic effect of valproate coadministration and hypoalbuminemia on the serum-free phenytoin concentration in patients with severe motor and intellectual disabilities. Clin. Neuropharmacol, 2002; 25:230-233.
Mantegazza, M., Curia, G., Biagini, G., et al. Voltage-gated sodium channels as therapeutic targets in epilepsy and other neurological disorders. Lancet Neurol, 2010; 9:413–424.
Mattson, R.H., Cramer, J.A. The choice of antiepileptic drugs in focal epilepsy. In: Wyllie E, editor. The treatment of epilepsy. Principles and practice. 1st ed. Philadelphia: Lea & Febiger, 1993; 817-23.
Messenheimer, J., Mullens, E., Giorgi, L., Young, F. Safety review of adult clinical trial experience with lamotrigine. Drug Safety, 1998; 18:281-296.
Patsalos, P.N., Froscher, W., Pisani, F., Van Rijn, C.M. The importance of drug interactions in epilepsy therapy. Epilepsia, 2002; 43:365-385.
Perucca, Е. Pharmacokinetics. In: Engel Jr J, Pedley T, editors. Epilepsy – a comprehensive tex Potschka, Н. Pharmacological treatment strategies: Mechanisms of antiepileptic drugs. Epileptology, 2013; 1(1): 31- 37.
Potschka, Н. Pharmacological treatment strategies: Mechanisms of antiepileptic drugs. Epileptology, 2013; 1(1): 31-37.
Poza, J.J. Management of epilepsy in the elderly. Neuropsychiatric Disease and Treatment, 2007; 3:723.
Rowan, A.J., Ramsay, R.E., Collins, J.F., Pryor, F., Boardman, K.D., Uthman, B.M., et al. VA Cooperative Study 428 Group. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005; 64(11):1868-1873.
Schmidt, D. Efficacy of New Antiepileptic Drugs. Epilepsy Curr., 2011; 11(1):9–11.
Smith, N., Tiwar, D. Epilepsy in older people. Rev Clin Gerontol, 2015; 25:53–59Spina, E., Perucca, E., Levy, R.H. Predictability of metabolic antiepileptic drug interactions, in Antiepileptic Drugs: Combination Therapy and Interactions, 1st edn (eds. J.Majkowski, B. Bourgeois, P.N. Patsalos, Mattson, R.H. Cambridge University Press, New York, NY, 2005; 57–92.
Tanaka, А., Akamatsu, N., Shouzaki, T., Toyota, T., Yamano, M., Nakagawa, M., Tsuji, S. Clinical characteristics and treatment responses in new-onset epilepsy in the elderly. November 2013; 22(9):772–775.
Theodor, W. M. Assessment of adverse effects of antiepileptic drugs: The patient's view. Epileptology, 2013; 1(1):46-54.
Verellen, R.M., Cavazos, J.E. Pathophysiological Considerations of Seizures, Epilepsy, and Status Epilepticus in the Elderly. Aging Dis., 2011; 2(4):278–285.
Witt, J.A., Helmstaedter, C. Monitoring the cognitive effects on antiepileptic pharmacotherapy. Epilepsy and Behavior, 2013; 26, 450-456.
Zaccara, G., Balestrieri, F., Ragazzoni, A. Management of side-effects of antiepileptic drugs. In: Shorvon S, Perucca E, Engel J Jr, eds. The treatment of epilepsy, 3rd edn. Oxford: Wiley-Blackwell, 2009; 289-300.
Downloads
Published
How to Cite
Issue
Section
ARK
License
Copyright (c) 2019 Diana Betsinska, P. Kolev, R. Kuzmanova
This work is licensed under a Creative Commons Attribution 4.0 International License.
