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Epilepsy in older adults is common, with an incidence equal to (if not higher) than infants.
The most common type is focal seizures, with strokes and neurodegenerative diseases being the most common underlying causes.
Management of epilepsy in the elderly is challenging because of many reasons:
- A large number of disorders may mimic seizures, and 25-50% of patients with presumed epilepsy end up diagnosed with non-epileptic events, such as tremor, non-epileptic myoclonus, syncope, confusion, agitation, cataplexy and limb-shaking TIAs.
- Status epileptics in the elderly has double the incidence of the general population and a significantly higher mortality rate.
- The role of newer anti-epileptics (drugs other than benzodiazepines, phenytoin and phenobarbital) is unclear due to lack of adequate studies in this age group.
- Antiepileptic drug clearance (both renal and hepatic) is affected by normal physiological changes in this age group, increasing the side effects and decreasing tolerance, even to doses lower than usual.
References
Carlson C, Anderson CT. Special Issues in Epilepsy: The Elderly, the Immunocompromised, and Bone Health. Continuum 2016;22(1):246 261