Treatment of seizures and epilepsy in older adults
- Hyunmi Choi, MD, MS
Hyunmi Choi, MD, MS
- Associate Professor of Neurology
- Columbia University Medical Center
- Anil Mendiratta, MD
Anil Mendiratta, MD
- Associate Professor of Neurology
- Columbia University College of Physicians and Surgeons
- Section Editors
- Timothy A Pedley, MD
Timothy A Pedley, MD
- Editor-in-Chief — Neurology
- Section Editor — Epilepsy
- Henry and Lucy Moses Professor of Neurology
- Columbia University College of Physicians and Surgeons
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
Treatment of seizures and epilepsy in older adults must take into account a variety of factors related to aging, including increased risk of polypharmacy and drug-drug interactions, altered drug metabolism, increased susceptibility to side effects, and multiple medical comorbidities. A seizure diagnosis has significant quality of life implications in older patients, who are already vulnerable to loss of independence, driving restrictions, impaired self-confidence, and risk of falls, which result in physical injury and other sequelae.
Acute symptomatic seizures are provoked events that are not expected to recur in the absence of a particular trigger (eg, hypoglycemia, alcohol withdrawal). Epilepsy is a condition in which recurrent unprovoked seizures are expected in the absence of treatment.
This topic will cover aspects of the management of seizures and epilepsy that are specific to older adults. A more general discussion of the treatment of seizures and epilepsy is presented elsewhere. The etiology, clinical presentation and diagnosis of seizures and epilepsy in older adults is also discussed separately. (See "Initial treatment of epilepsy in adults" and "Overview of the management of epilepsy in adults" and "Seizures and epilepsy in older adults: Etiology, clinical presentation, and diagnosis".)
In general, patients with acute symptomatic seizures due to obvious metabolic derangements, medication, or medication withdrawal will not require seizure treatment. Patients with acute seizures caused by an acute intracranial event (stroke, head trauma) are often treated for a limited time (a few weeks to a few months). If seizures do not recur, withdrawal of antiseizure drugs should be considered depending on the patient's other risk factors and comorbidity. (See "Overview of the management of epilepsy in adults", section on 'Post-stroke seizures'.)
Risk of recurrence after first seizure — There are few data regarding the risk of seizure recurrence in older patients with unprovoked seizures, but rates of 80 to 90 percent are often mentioned. In part, this has been inferred from a high rate of recurrence in patients with late-onset seizures following stroke and also from studies in the general adult epilepsy population in which the seizure recurrence rate in the setting of a known underlying cause is as high as 80 percent.
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