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Antiepileptic drugs for older people

Published online by Cambridge University Press:  01 February 2008

Peter Burbridge*
Affiliation:
The Royal Bournemouth Hospital., Bournemouth, UK
Stephen Allen
Affiliation:
The Royal Bournemouth Hospital., Bournemouth, UK
Michael Vassallo
Affiliation:
The Royal Bournemouth Hospital., Bournemouth, UK
Joseph Kwan
Affiliation:
The Royal Bournemouth Hospital., Bournemouth, UK
*
Address for correspondence: PM Burbridge, Elderly Care Medicine, Royal Berkshire NHS Foundation Trust, London Road, Reading RG1 5AN, UK.

Extract

Epilepsy in older people is a common problem. It is estimated that in Europe there are 85 000 new cases of epilepsy annually in those over 65 years old, equivalent to an incidence of 100 per 100 000. Incidence increases with age and the rate in older people is higher than in all but the first year of life. The older population has a median prevalence of 4.7 per 1000 (range 3.0 to 7.3) from nine studies and may be underestimated by case-ascertainment bias common to many studies of older people.

Type
Clinical geriatrics
Copyright
Copyright © Cambridge University Press 2008

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References

1Forsgren, L, Beghi, E, Oun, A, Sillanpaa, M. The epidemiology of epilepsy in Europe – a systematic review. Eur J Neurol 2005; 12:245–53.CrossRefGoogle ScholarPubMed
2Stolarek, IH, Brodie, AF, Brodie, MJ. Management of seizures in the elderly: a survey of UK geriatricians. J R Soc Med 1995; 88:686–89.CrossRefGoogle ScholarPubMed
3Lhatoo, SD, Sander, JW. Cause-specific mortality in epilepsy. Epilepsia 2005; 46 (suppl 11):3639.CrossRefGoogle ScholarPubMed
4Pugh, MJ, Cramer, J, Knoefel, J et al. Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy. J Am Geriatr Soc 2004; 52:417–22.CrossRefGoogle ScholarPubMed
5Pugh, MJV, Van Cott, AC, Cramer, JA et al. Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000–2004. Neurology 2008; 70:2171–78.CrossRefGoogle ScholarPubMed
6NICE. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. London: National Institute for Clinical Excellence; 2004 Available from: http://www.nice.org.uk/Guidance/CG20.Google Scholar
7SIGN. Diagnosis and Management of Epilepsy in Adults. Edinburgh: Scottish Intercollegiate Guidelines Network; 2003. Available from: http://www.sign.ac.uk/guidelines/fulltext/70/index.html.Google Scholar
8Galimberti, CA, Magri, F, Magnani, B et al. Antiepileptic drug use and epileptic seizures in elderly nursing home residents: a survey in the province of Pavia, Northern Italy. Epilepsy Res 2006; 68:18.CrossRefGoogle ScholarPubMed
9Harms, SL, Eberly, LE, Garrard, JM et al. Prevalence of appropriate and problematic antiepileptic combination therapy in older people in the nursing home. J Am Geriatr Soc 2005; 53:1023–08.CrossRefGoogle ScholarPubMed
10Huying, F, Klimpe, S, Werhahn, KJ. Antiepileptic drug use in nursing home residents: a cross-sectional, regional study. Seizure 2006; 15:194–97.CrossRefGoogle ScholarPubMed
11Loiseau, J, Loiseau, P, Duche, B et al. A survey of epileptic disorders in southwest France: seizures in elderly patients. Ann Neurol 1990; 27:232–37.CrossRefGoogle ScholarPubMed
12LaRoche, SM, Helmers, SL. Epilepsy in the elderly. Neurologist 2003; 9:241–49.CrossRefGoogle ScholarPubMed
13Hauser, WA, Annegers, JF, Kurland, LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 1993; 34:453–68.CrossRefGoogle ScholarPubMed
14Brodie, MJ, Kwan, P. Epilepsy in elderly people. BMJ 2005; 331:1317–22.CrossRefGoogle ScholarPubMed
15Hart, YM, Sander, JW, Johnson, AL, Shorvon, SD. National General Practice Study of Epilepsy: recurrence after a first seizure. Lancet 1990; 336:1271–74.CrossRefGoogle ScholarPubMed
16Hauser, WA, Rich, SS, Lee JR, Annegers, JF, Anderson, VE. Risk of recurrent seizures after two unprovoked seizures. N Engl J Med 1998; 338:429–34.CrossRefGoogle ScholarPubMed
17Marson, A, Jacoby, A, Johnson, A et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomised controlled trial. Lancet. 2005; 365:2007–13.CrossRefGoogle ScholarPubMed
18Kim, LG, Johnson, TL, Marson, AG, Chadwick, DW. Prediction of risk of seizure recurrence after a single seizure and early epilepsy: further results from the MESS trial. Lancet Neurol 2006; 5:317–22.CrossRefGoogle ScholarPubMed
19Drury, I, Beydoun, A. Interictal epileptiform activity in elderly patients with epilepsy. Electroencephalogr Clin Neurophysiol 1998; 106:369–73.CrossRefGoogle ScholarPubMed
20Bladin, CF, Alexandrov, AV, Bellavance, A et al. Seizures after stroke: a prospective multicenter study. Arch Neurol 2000; 57:1617–22.CrossRefGoogle ScholarPubMed
21Lamy, C, Domigo, V, Semah, F et al. Early and late seizures after cryptogenic ischemic stroke in young adults. Neurology 2003; 60:400–04.CrossRefGoogle ScholarPubMed
22Lossius, MI, Ronning, OM, Slapo, GD, Mowinckel, P, Gjerstad, L. Poststroke epilepsy: occurrence and predictors–a long-term prospective controlled study (Akershus Stroke Study). Epilepsia 2005; 46:1246–51.CrossRefGoogle ScholarPubMed
23Olsen, TS. Post-stroke epilepsy. Curr Atheroscler Rep 2001; 3:340–44.CrossRefGoogle ScholarPubMed
24Sung, CY, Chu, NS. Epileptic seizures in thrombotic stroke. J Neurol 1990; 237:166–70.CrossRefGoogle ScholarPubMed
25Hesdorffer, DC, Hauser, WA, Annegers, JF, Kokmen, E, Rocca, WA. Dementia and adult-onset unprovoked seizures. Neurology 1996; 46:727–30.CrossRefGoogle ScholarPubMed
26Amatniek, JC, Hauser, WA, Del Castillo-Castaneda, C et al. Incidence and predictors of seizures in patients with Alzheimer's disease. Epilepsia 2006; 47: 867–72.CrossRefGoogle ScholarPubMed
27Kramer, G. Epilepsy in the elderly: some clinical and pharmacotherapeutic aspects. Epilepsia 2001; 42 (suppl 3):59.CrossRefGoogle ScholarPubMed
28Mohanraj, R, Brodie, MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules. Eur J Neurol 2006; 13:277–82.CrossRefGoogle ScholarPubMed
29Faught, E. Monotherapy in adults and elderly persons. Neurology 2007; 69 (suppl 3): S39.CrossRefGoogle ScholarPubMed
30Baulac, M. Rational conversion from antiepileptic polytherapy to monotherapy. Epileptic Disord 2003 5:125–32.CrossRefGoogle ScholarPubMed
31Piazzini, A, Canevini, MP, Turner, K, Chifari, R, Canger, R. Elderly people and epilepsy: cognitive function. Epilepsia 2006; 47 (suppl 5):8284.CrossRefGoogle ScholarPubMed
32Glauser, T, Ben-Menachem, E, Bourgeois, B et al. ILAE treatment guidelines: evidence-based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia 2006; 47:1094–20.CrossRefGoogle ScholarPubMed
33Rowan, AJ, Ramsay, RE, Collins, JF et al. New-onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology 2005; 64:1868–73.CrossRefGoogle ScholarPubMed
34Brodie, MJ, Overstall, PW, Giorgi, L. Multicentre, double-blind, randomised comparison between lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine Elderly Study Group. Epilepsy Res 1999; 37:8187.CrossRefGoogle ScholarPubMed
35Privitera, MD, Brodie, MJ, Mattson, RH et al. Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand 2003; 107:165–75.CrossRefGoogle ScholarPubMed
36Saetre, E, Perucca, E, Isojarvi, J, Gjerstad, L. An international multicenter randomized double-blind controlled trial of lamotrigine and sustained-release carbamazepine in the treatment of newly diagnosed epilepsy in the elderly. Epilepsia 2007; 48:1292–302.CrossRefGoogle ScholarPubMed
37Marson, AG, Al-Kharusi, AM, Alwaidh, M et al. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial. Lancet 2007; 369:1000–15.CrossRefGoogle ScholarPubMed
38Cramer, JA, Leppik, IE, Rue, KD, Edrich, P, Kramer, G. Tolerability of levetiracetam in elderly patients with CNS disorders. Epilepsy Res 2003; 56:135–45.CrossRefGoogle ScholarPubMed
39Alsaadi, TM, Koopmans, S, Apperson, M, Farias, S. Levetiracetam monotherapy for elderly patients with epilepsy. Seizure 2004; 13:5860.CrossRefGoogle ScholarPubMed
40Ferrendelli, JA, French, J, Leppik, I 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; 4:702–09.CrossRefGoogle Scholar
41Bauer, J, Ben-Menachem, E, Kramer, G et al. Levetiracetam: a long-term follow-up study of efficacy and safety. Acta Neurol Scand 2006; 114:169–76.CrossRefGoogle ScholarPubMed
42Groselj, J, Guerrini, R, Van Oene, J et al. Experience with topiramate monotherapy in elderly patients with recent-onset epilepsy. Acta Neurol Scand 2005; 112:144–50.CrossRefGoogle ScholarPubMed
43Kutluay, E, McCague, K, D'Souza, J, Beydoun, A. Safety and tolerability of oxcarbazepine in elderly patients with epilepsy. Epilepsy Behav 2003; 4:175–80.CrossRefGoogle ScholarPubMed
44Mattson, RH, Cramer, JA, Collins, JF. A comparison of valproate with carbamazepine for the treatment of complex partial seizures and secondarily generalized tonic-clonic seizures in adults. The Department of Veterans Affairs Epilepsy Cooperative Study No. 264 Group. N Engl J Med 1992; 327:765–71.CrossRefGoogle ScholarPubMed
45Karceski, S, Morrell, MJ, Carpenter, D. Treatment of epilepsy in adults: expert opinion, 2005. Epilepsy Behav 2005; (suppl 10): 64; quiz S57.Google Scholar
46Birnbaum, A, Hardie, NA, Leppik, IE et al. Variability of total phenytoin serum concentrations within elderly nursing home residents. Neurology 2003; 60:555–59.CrossRefGoogle ScholarPubMed
47Patsalos, PN, Berry, DJ, Bourgeois, BF et al. Antiepileptic drugs–best practice guidelines for therapeutic drug monitoring: a position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008; 49:1239–76.CrossRefGoogle ScholarPubMed
48Perucca, E, Aldenkamp, A, Tallis, R, Kramer, G. Role of valproate across the ages. Treatment of epilepsy in the elderly. Acta Neurol Scand Suppl 2006; 184:2837.CrossRefGoogle ScholarPubMed
49Newton, HB, Goldlust, SA, Pearl, D. Retrospective analysis of the efficacy and tolerability of levetiracetam in brain tumor patients. J Neurooncol 2006; 78:99102.CrossRefGoogle ScholarPubMed
50Vecht, CJ, Wagner, GL, Wilms, EB. Interactions between antiepileptic and chemotherapeutic drugs. Lancet Neurol 2003; 2:404–09.CrossRefGoogle ScholarPubMed
51Ensrud, KE, Walczak, TS, Blackwell, T et al. Antiepileptic drug use increases rates of bone loss in older women: a prospective study. Neurology 2004; 62:2051–57.CrossRefGoogle ScholarPubMed
52Sato, Y, Kondo, I, Ishida, S et al. Decreased bone mass and increased bone turnover with valproate therapy in adults with epilepsy. Neurology 2001; 57:445–49.CrossRefGoogle ScholarPubMed
53Mintzer, S, Boppana, P, Toguri, J, DeSantis, A. Vitamin D levels and bone turnover in epilepsy patients taking carbamazepine or oxcarbazepine. Epilepsia 2006; 47:510–15.CrossRefGoogle ScholarPubMed
54Drezner, MK. Treatment of anticonvulsant drug-induced bone disease. Epilepsy Beh 2004; (suppl 2):41–7.CrossRefGoogle Scholar
55Persson, HB, Alberts, KA, Farahmand, BY, Tomson, T. Risk of extremity fractures in adult outpatients with epilepsy. Epilepsia 2002; 43:768–72.CrossRefGoogle ScholarPubMed
56Sheth, RD, Harden, CL. Screening for bone health in epilepsy. Epilepsia 2007; 48 (suppl 9):3941.CrossRefGoogle ScholarPubMed
57Kenneback, G, Ericson, M, Tomson, T, Bergfeldt, L. Changes in arrhythmia profile and heart rate variability during abrupt withdrawal of antiepileptic drugs. Implications for sudden death. Seizure 1997; 6:369–75.CrossRefGoogle ScholarPubMed
58Fife, TD, Blum, D, Fisher, RS. Measuring the effects of antiepileptic medications on balance in older people. Epilepsy Res 2006; 70:103–09.CrossRefGoogle ScholarPubMed
59Ensrud, KE, Blackwell, TL, Mangione, CM et al. Central nervous system-active medications and risk for falls in older women. J Am Geriatr Soc 2002; 50:1629–37.CrossRefGoogle ScholarPubMed
60Ryvlin, P, Montavont, A, Nighoghossian, N. Optimizing therapy of seizures in stroke patients. Neurology 2006; 67 (suppl 4):S39.CrossRefGoogle ScholarPubMed
61Kwan, J, Hand, P, Kinton, L. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. (Protocol). Cochrane Database of Systematic Reviews. 2005 (Issue 3): Art. No.: CD005398.CrossRefGoogle Scholar
62Goldstein, LB. Common drugs may influence motor recovery after stroke. The Sygen In Acute Stroke Study Investigators. Neurology 1995; 45:8651071.CrossRefGoogle ScholarPubMed
63Naidech, AM, Kreiter, KT, Janjua, N et al. Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke 2005; 36:583–87.CrossRefGoogle ScholarPubMed
64Alvarez-Sabin, J, Montaner, J, Padro, L et al. Gabapentin in late-onset poststroke seizures. Neurology. 2002; 59:1991–93.CrossRefGoogle ScholarPubMed
65Garcia-Escriva, A, Lopez-Hernandez, N. [The use of levetiracetametiracetam in monotherapy in post-stroke seizures in the elderly population]. Revista de Neurologia. 2007; 45:523–25.Google ScholarPubMed
66Gilad, R, Sadeh, M, Rapoport, A et al. Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clin Neuropharmacol 2007; 30:189–95.CrossRefGoogle ScholarPubMed
67Patsalos, PN, Perucca, E. Clinically important drug interactions in epilepsy: interactions between antiepileptic drugs and other drugs. Lancet Neurol 2003; 2:473–81.CrossRefGoogle ScholarPubMed
68Goulden, KJ, Dooley, JM, Camfield, PR, Fraser, AD. Clinical valproate toxicity induced by acetylsalicylic acid. Neurology 1987; 37:1392–94.CrossRefGoogle ScholarPubMed
69Sandson, NB, Marcucci, C, Bourke, DL, Smith-Lamacchia, R. An interaction between aspirin and valproate: the relevance of plasma protein displacement drug-drug interactions. Am J Psychiatry 2006; 163:1891–96.CrossRefGoogle ScholarPubMed
70NICE. Clinical Guideline 68. Stroke: diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: National Institute for Clinical Excellence; 2008.Google Scholar
71Joint Formulary Committee. British National Formulary. 55 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2008.Google Scholar
72Meador, KJ. Cognitive outcomes and predictive factors in epilepsy. Neurology 2002; 58 (suppl 5):S2126.CrossRefGoogle ScholarPubMed
73Cordonnier, C, Henon, H, Derambure, P, Pasquier, F, Leys, D. Early epileptic seizures after stroke are associated with increased risk of new-onset dementia. J Neurol Neurosurg Psychiatry 2007; 78:514–16.CrossRefGoogle ScholarPubMed
74Turnheim, K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol 2003; 38:843–53.CrossRefGoogle ScholarPubMed
75Griffith, HR, Martin, RC, Bambara, JK, Marson, DC, Faught, E. Older adults with epilepsy demonstrate cognitive impairments compared with patients with amnestic mild cognitive impairment. Epilepsy Behav 2006; 8:161–68.CrossRefGoogle ScholarPubMed
76Smith, DB, Mattson, RH, Cramer, JA et al. Results of a nationwide Veterans Administration Cooperative Study comparing the efficacy and toxicity of carbamazepine, phenobarbital, phenytoin, and primidone. Epilepsia 1987; 28 (suppl 3):S5058.CrossRefGoogle ScholarPubMed
77Tatum, WO, French, JA, Faught, E et al. Postmarketing experience with topiramate and cognition. Epilepsia 2001; 42:1134–40.CrossRefGoogle ScholarPubMed
78Aldenkamp, AP, Baker, G, Mulder, OG et al. A multicenter, randomized clinical study to evaluate the effect on cognitive function of topiramate compared with valproate as add-on therapy to carbamazepine in patients with partial-onset seizures. Epilepsia 2000; 41:1167–78.CrossRefGoogle ScholarPubMed
79Aldenkamp, AP, Arends, J, Bootsma, HP et al. Randomized double-blind parallel-group study comparing cognitive effects of a low-dose lamotrigine with valproate and placebo in healthy volunteers. Epilepsia 2002; 43:1926.CrossRefGoogle ScholarPubMed
80Aulakh, JS, Hawkins, JW, Athwal, HS et al. Tolerability and effectiveness of lamotrigine in complex elderly patients. J Geriatr Psychiatry Neurol 2005; 18:811.CrossRefGoogle ScholarPubMed
81Meador, KJ, Loring, DW, Ray, PG et al. Differential cognitive and behavioral effects of carbamazepine and lamotrigine. Neurology 2001; 56:1177–82.CrossRefGoogle ScholarPubMed
82Belcastro, V, Costa, C, Galletti, F et al. Levetiracetam monotherapy in Alzheimer patients with late-onset seizures: a prospective observational study. Eur J Neurol 2007; 14:1176–68.CrossRefGoogle ScholarPubMed
83Kyomen, HH, Whitfield, TH, Baldessarini, RJ. Levetiracetam for manic behavior in hospitalized geriatric patients with dementia of the Alzheimer's type. J Clin Psychopharmacol 2007; 27:408–10.CrossRefGoogle ScholarPubMed
84Weiner, MF, Womack, KB, Martin-Cook, K, Svetlik, DA, Hynan, LS. Levetiracetam for agitated Alzheimer's disease patients. Int Psychogeriatr 2005; 1:327–8.CrossRefGoogle Scholar
85Bergey, GK. Initial treatment of epilepsy: special issues in treating the elderly. Neurology 2004; 63 (suppl 4):S4048.CrossRefGoogle ScholarPubMed
86McLaughlin, DP, Pachana, NA, McFarland, K. Depression in a community-dwelling sample of older adults with late-onset or lifetime epilepsy. Epilepsy Behav 2008; 12:281–85.CrossRefGoogle ScholarPubMed
87Perucca, E, Berlowitz, D, Birnbaum, A et al. Pharmacological and clinical aspects of antiepileptic drug use in the elderly. Epilepsy Res 2006; 68 (suppl 1):S4963.CrossRefGoogle ScholarPubMed
88Sheorajpanday, RV, De Deyn, PP. Epileptic fits and epilepsy in the elderly: general reflections, specific issues and therapeutic implications. Clin Neurol Neurosurg 2007; 109:727–43.CrossRefGoogle ScholarPubMed
89Alldredge, BK. Seizure risk associated with psychotropic drugs: clinical and pharmacokinetic considerations. Neurology 1999; 53 (suppl 2): S6875.Google ScholarPubMed
90Biton, V, Mirza, W, Montouris, G et al. Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy. Neurology 2001; 56:172–77.CrossRefGoogle ScholarPubMed
91Faught, E, Ayala, R, Montouris, GG, Leppik, IE. Randomized controlled trial of zonisamide for the treatment of refractory partial-onset seizures. Neurology 2001; 57:1774–79.CrossRefGoogle ScholarPubMed
92Ben-Menachem, E, Axelsen, M, Johanson, EH, Stagge, A, Smith, U. Predictors of weight loss in adults with topiramate-treated epilepsy. Obes Res 2003; 11:556–62.CrossRefGoogle ScholarPubMed
93Chihorek, AM, Abou-Khalil, B, Malow, BA. Obstructive sleep apnea is associated with seizure occurrence in older adults with epilepsy. Neurology 2007; 69:1823–27.CrossRefGoogle ScholarPubMed
94Nieto-Barrera, M, Brozmanova, M, Capovilla, G et al. A comparison of monotherapy with lamotrigine or carbamazepine in patients with newly diagnosed partial epilepsy. Epilepsy Res 2001; 46:145–55.CrossRefGoogle ScholarPubMed
95Cloyd, JC, Remmel, RP. Antiepileptic drug pharmacokinetics and interactions: impact on treatment of epilepsy. Pharmacotherapy 2000; 20 (Pt 2):139S–51S.CrossRefGoogle ScholarPubMed