Epilepsy can occur at any age. However, it is most common in both the young and older patients. In young patients there is much that is known about the management of seizures in children. However, older adults are often treated as though they are like every other younger aged individual. There are unique aspects to the treatment of seizures in older adults. It is important for both the older adult with seizures, as well as the healthcare professional caring for the older adult with epilepsy, to know the four basic principles that should guide all treatment decisions when dealing with seizures in those over the age of 60 years.
- When starting medications it is essential that one go slower and lower dose than a younger aged individual. Older adults have more difficulty in tolerating the side effects associated with commonly utilized antiseizure drugs. The old adage of “go slow and low” is the most important one to remember when using any medication in older adults.
- Almost all medications used for seizures will work in an older adult. What is more important are side effects. Given that all seizure medications have side effects it is important to know and understand the unique side effects of any given seizure drug and avoid using a drug if the older age adult has a problem that the drug may exacerbate. An example of this is carbamazepine, which commonly causes low sodium. If an older adult has issues with low sodium or has heart issues, avoiding carbamazepine would be important. Therefore, know the side effects of drugs, as side effects are what will decide how an older adult will fare on a seizure therapy.
- It is essential that one understand all potential drug interactions. Older adults are often on a number of medications. In fact, the average older adult can be on a range of medications from seven to thirteen other pills. Therefore, picking seizure drugs that do not cause drug interactions is essential in promoting good management of seizures in this group.
- Understand that the number one cause of nursing home admissions in the United States is falling. Therefore, avoiding medications or preventing problems that lead to gait disturbances or imbalance is important. Try to pick medications or at least know those medications that cause dizziness or imbalance because this can lead to a fall; a fall can lead to a hip fracture; and hip fracture leads to nursing home admission. Nursing home admission in turn leads to loss of independence. It is essential to know which medications can cause this effect.
If one follows these four common principles in treating seizures in the older adult, one will likely improve quality of life, lead to better outcomes and happier individuals.
Joseph I. Sirven, MD
Last Reviewed: 11/15/11