Managing Epilepsy in Older Adults: Medicine Side Effects and Safety

This week's review of seizures in older adults highlights important information for managing seizures and safety. People have a very good chance of seizure control, but managing seizure medicines requires careful attention to side effects.

On a practical level, what does this mean to the person with epilepsy and their loved ones?

Seizure control is important, but side effects of treatments can lead to safety problems in some people. Some potential side effects may be more of a problem in older adults due to normal effects of getting older – bones may be thinner making people at greater risk of fractures, memory may not be as sharp, vision changes, and strength or balance may not be as good. Consider the following examples and how they may affect someone who develops epilepsy later in life.

• Dizziness, poor coordination or unsteady walking can lead to bumping into objects when walking or falls.

• Blurry or double vision can make it difficult to walk safely and place a person at risk for other injuries – for example burns from cooking or doing household chores or other activities that require clear vision.

• Hand tremors may cause problems holding things safely. People can drop objects more easily, burn or cut themselves. People may have difficulty eating if they can't hold their utensils or cups steady.

• Changes in thinking, remembering or concentrating may make it difficult to follow medicine instructions or know what to do if side effects occur.

Can medicine side effects be prevented? Any medicine has the potential to cause side effects in an individual, but the type of side effects may vary from one drug to another. Careful selection of which medicine to use when a person is diagnosed with epilepsy can sometimes prevent the development of bothersome side effects.

• Matching the seizure medicine to the individual and the risk for side effects and injuries: For example, avoiding medicines that cause cognitive problems, visual changes, or thinning of the bones would be important for older adults.

• Selecting medicines that don't interact with other medicines: .As people get older, they are more likely to be on medicines for other health problems. Choosing a seizure medicine should take this into consideration. Try to use a medicine that doesn't interact with other drugs and that won't interfere with other health problems.

• Keeping open lines of communication with your doctor: It's critical for people with epilepsy to tell their health care providers about all other health problems that could affect safety. Don't just tell them about your walking or vision. Make sure they know about other health conditions you may have and what other medicines you take.

• Know what to expect: Learn about any new medicine you are taking. For example, know the common reactions that may go away, dose-related side effects, and signs of more serious problems. Then make sure you know what to do if any of these occur and when to call the doctor.

How do I manage side effects if they occur? If falls, injuries or other problems occur after starting a new medicine, consider these tips.

• Talk to your doctor or the health care professional about the dose and when changes are supposed to be made. Sometimes making changes more slowly or trying a lower dose may be suggested.

• Take the medicine the same way every day and at the same time of day.

• Taking it after food may help even out the way the medicine is absorbed and lessen side effects.

• If more than one medicine is taken at the same time, talk to your doctor. Sometimes adjusting the times of the different meds helps lessen side effects.

• Talk to your doctor or nurse about your lifestyle. Adjusting the times of meds around your lifestyle may help, for example taking higher doses of a medicine at night if it makes you sleepy, rather than during the day when you are most active.

• Write down when the problems occur and any other factors that may be going on at the same time. Maybe something else is going on that's causing some problems.

How can I prevent falls or other injuries?

• Get a home safety evaluation to look at potential risks in your home. Are their obstacles such as scatter rugs or furniture that can be rearranged to prevent falls? Look at the most commonly used rooms in your house – kitchen, bathroom, and living areas.

• Seek help from an occupational therapist for daily activities and safety at home.

  • Would a bench or chair prevent you from falling in the shower?

  • Would a hand held shower nozzles be easier to use?

  • How about tips to cook more safely?

• A physical therapist can help with walking, balance, climbing stairs, and managing pain from injuries. They can help you with exercises if needed and aids that may help you get around safer.

What can I do if I live alone? Some people who are having frequent seizures, undergoing medicine changes, or are at risk for falls or other injuries may need help in the home or at least know how to get help if they need it.

• Talk to a social worker and see if you could get help from home health aide or personal care attendants in the home.

• Talk to family and friends about what kind of help may be available from them. Can you hire help for chores you can't do alone?

• Consider online shopping and delivery services so you don't have to shop alone or if you can't drive.

• Look into a system to alert someone if you fall or need help. These are called 'medical alert systems' and can be easily obtained from local hospitals, or look online for services in your area.

• Set up your cellphone so it's easy to call someone for help.

• Look at new technology that's available – the SmartMontitor is one that's available now and others are being developed. These can detect if a person is having an event that affects movement and can notify someone for help if it's needed.

• Talk to your local emergency responders and let them know what to do or who to call if you have a seizure or other emergency situation.

• Create your own Seizure Response Plan in My Epilepsy Diary - keep a copy in your home, give one to family members or friends who may be in a position to help you.