Management of Epilepsy in Older People

Abstract

Epilepsy is a relatively common disorder among older people, with the incidence increasing significantly with age. In Australia, epilepsy is a major cause of disability in the elderly and, in the context of an ageing population, it is of increasing importance as a public health issue. The aetiology of epilepsy in older people and the spectrum of epilepsy and seizure type differs from the younger population. Making the diagnosis of epilepsy in the elderly poses particular difficulties. There are multiple medications available for the management of seizures, a number of which have been introduced only within the last decade, and have not been systematically studied in older people. Age‐related changes in metabolism, physiology, and pathology alter the pharmacokinetics of these medications, and these need to be taken into consideration when treating elderly patients with an antiepileptic drug. This article reviews the causes of seizures, issues regarding commencement of an antiepileptic drug, and age‐related changes in pharmacokinetics of these medications.