Periodic reassessment of seniors with epilepsy is important, as with any chronic condition. If different caregivers are involved, either sequentially or simultaneously, reassessment is even more essential.

Underreporting of symptoms has been well documented in the elderly.81 Family members or visiting nurses should be enlisted to ensure adequate reporting. They also can be critical to ensuring that seniors comply with medication regimens, given possible problems with cognitive, sensory, and motor deficits and social isolation.

Areas to be specifically questioned include:

  • seizure frequency, including simple partial seizures
  • compliance with antiepileptic drug (AED) regimens
  • adverse drug effects
  • new drugs that can potentially interact with AEDs
  • newly diagnosed conditions such as cardiac, renal, or hepatic disease.

Periodic monitoring of blood chemistries and AED levels is probably more useful for this age group than for younger patients. Monitoring may detect long-term changes before they become symptomatic.

The possibility of adding or substituting one of the newer AEDs should be considered, although in general a change in therapy should be avoided if seizures are controlled without significant adverse drug effects.

Withdrawal of AEDs

If it can be verified that the patient has been free from seizures for at least 2 years, the possibility of drug withdrawal can be raised. A prospective study82 of the risk of seizure recurrence in this circumstance did not find advanced age to be a significant risk factor in a multivariate analysis. Under the best of circumstances, one-third to one-half of patients experience a relapse after drug withdrawal.

EEG testing has limited value in this decision. As at any age, an important issue is the risk of injury or social limitation (e.g., driving restriction) if a relapse occurs.

Adapted from: Bromfield EB. Epilepsy and the elderly. In: Schachter SC, Schomer DL, eds. The comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 233-254.
With permission from Elsevier (www.elsevier.com).

Authored By: 
Edward Bromfield MD
Steven C. Schachter MD
Donald L. Schomer MD
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