Diagnosis and treatment selection in elderly patients with epilepsy

Gregory K Bergey, Angela K. Birnbaum, Filissa M. Caserta, James A. Ferrendelli, Jacqueline A. French, Ilo Leppik

Research output: Contribution to journalArticle

Abstract

Demographic data indicate that new-onset epilepsy is more prevalent in the elderly than in any other age group. Because unprovoked seizures in this age group are frequently due to symptomatic causes (most commonly cerebrovascular), treatment is typically lifelong; therefore, the selection of an appropriate antiepileptic drug (AED) is of critical importance for this patient cohort. First- and second-generation AEDs are available as potential therapy and offer physicians several options. Nonetheless, there is a paucity of rigorous data comparing the efficacy of these agents, and few well-controlled trials examine their use in the elderly population. One recently published landmark study that was begun in the 1990s, the Veterans Affairs Cooperative Study 428, objectively examined treatment issues in an elderly cohort with new-onset epilepsy. Results from this study indicate that successful treatment must take into account tolerability and efficacy. Evidence suggests that select second-generation agents may offer distinct advantages over first-generation agents in elderly patients with epilepsy. In light of these clinical trial results and the specific needs of this patient group, there is a need to revisit treatment practices in the elderly cohort. The treatment parameters of first- and second-generation AEDs in the elderly are evaluated for pharmacokinetics, drug interactions, cognitive profiles, and safety profiles. Selection of certain new AEDs as early therapy in elderly patients with epilepsy can now be strongly advocated, but implementation of these practices requires further educational initiatives targeted to physicians who initially treat these patients.

Original languageEnglish (US)
JournalAdvanced Studies in Medicine
Volume6
Issue number3 C
StatePublished - Mar 2006

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Epilepsy
Therapeutics
Age Groups
Physicians
Veterans
Secondary Prevention
Drug Interactions
Anticonvulsants
Seizures
Pharmacokinetics
Demography
Clinical Trials
Safety
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bergey, G. K., Birnbaum, A. K., Caserta, F. M., Ferrendelli, J. A., French, J. A., & Leppik, I. (2006). Diagnosis and treatment selection in elderly patients with epilepsy. Advanced Studies in Medicine, 6(3 C).

Diagnosis and treatment selection in elderly patients with epilepsy. / Bergey, Gregory K; Birnbaum, Angela K.; Caserta, Filissa M.; Ferrendelli, James A.; French, Jacqueline A.; Leppik, Ilo.

In: Advanced Studies in Medicine, Vol. 6, No. 3 C, 03.2006.

Research output: Contribution to journalArticle

Bergey, GK, Birnbaum, AK, Caserta, FM, Ferrendelli, JA, French, JA & Leppik, I 2006, 'Diagnosis and treatment selection in elderly patients with epilepsy', Advanced Studies in Medicine, vol. 6, no. 3 C.
Bergey GK, Birnbaum AK, Caserta FM, Ferrendelli JA, French JA, Leppik I. Diagnosis and treatment selection in elderly patients with epilepsy. Advanced Studies in Medicine. 2006 Mar;6(3 C).
Bergey, Gregory K ; Birnbaum, Angela K. ; Caserta, Filissa M. ; Ferrendelli, James A. ; French, Jacqueline A. ; Leppik, Ilo. / Diagnosis and treatment selection in elderly patients with epilepsy. In: Advanced Studies in Medicine. 2006 ; Vol. 6, No. 3 C.
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