Evidence⁃based evaluation of therapeutic measures for epilepsy in the elderly

Abstract

Objective To evaluate the efficacy and adverse reactions of different drug treatment options for senile epilepsy, and to develop the best solution of the evidence ⁃ based therapy for senile epilepsy. Methods Taking elderly epilepsy, drug therapy, evidence ⁃ based medicine as search terms, retrieve in databases such as PubMed, Cochrane Library, and MEDLINE, assisted by manual searching, in order to collect relevant literature including clinical guidelines, systematic reviews, randomized controlled clinical trials, clinical controlled trials, retrospective case analysis and case observation and research. Jadad Scale was used to evaluate the quality of literature. Results Almost 20 related articles were selected including 1 clinical guideline, 14 systematic reviews, 1 randomized controlled clinical trial, 2 clinical controlled trials and 2 retrospective case analysis. According to Jadad Scale, 15 articles were evaluated as high⁃quality literature (Grades ≥ 4), and the other 5 were evaluated as low⁃quality literature (Grades < 4). Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1) Antiepileptic drugs (AEDs) therapy is the main treatment for elderly patients with epilepsy. 2) The second⁃generation AEDs are not better than the first⁃generation AEDs in efficacy, but have advantages such as fewer adverse reactions, little drug interactions, and higher safety and tolerability. 3) Lamotrigine, levetiracetam and gabapentin are recommended to be first⁃line drugs, followed by topiramate and valproate. Influenced by multiple diseases, long ⁃ term multi ⁃ drug therapies and other factors, personalized treatment planning shall be adopted for elderly patients with epilepsy. 4) For new cases of epilepsy, monotherapy is preferred with lower dose, slow increase, longer interval between dosage and the improvement of compliance. Conclusion Evidence⁃based medicine can provide the best clinical evidence assessment method for elderly patients with epilepsy. DOI：10.3969/j.issn.1672⁃6731.2012.05.010