Care in people 60 years of age and over with chronic or recently diagnosed epilepsy: A note review in United Kingdom general practice

Abstract

Aim To ascertain present United Kingdom (UK) management processes for epilepsy in older people. Method This was a general practice notes review of people being treated for epilepsy 60 years and over. Results The cohort of 110 was from six practices. Seizure frequency in older people with epilepsy appears lower than in general; 75% are seizure free. This compares with 40–60% of people in other general practice note reviews and audits, where age is not a factor. Out of the people still having seizures over half have less than one seizure per month. Monotherapy rates are similar to the population in general. Nobody was taking more than two AEDs. There is evidence of new AED use, especially lamotrigine; it is the most commonly prescribed AED in those diagnosed in later life. Geriatricians appear to receive virtually no referrals for the diagnosis of epilepsy. General physicians, psychiatrists and neurologists receive many more. Geriatricians and general physicians appear never to follow up older people with epilepsy; GPs following up 91%, and neurologists and specialist nurses 9%. Conclusions Seizure frequency in older people with epilepsy is generally low. Geriatricians appear to receive virtually no referrals for the diagnosis or management of epilepsy in older people. Follow up is mainly undertaken by GPs. Although lamotrigine has a difficult dosing schedule, which may be confusing for some older people, its use is high perhaps reflecting recent guidelines and evidence. These results may be peculiar to the geographical area used, so other work is needed to confirm or refute these findings.