Document Detail

Selection of antiepileptic drugs in older people.
MedLine Citation:
PMID:  24756539     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Elderly people are one of the fastest-growing populations in the United States, and the incidence of epilepsy in older people is much higher than in other population subgroups. This age group is the most vulnerable because of the increased incidence of multiple medical comorbidities, including stroke. The diagnosis of epilepsy is extremely challenging and often delayed in this age group because of an atypical presentation. Seizures are manifest through extremely vague complaints, such as episodes of altered mental status or memory lapses. Once the diagnosis is established by careful history taking and diagnostic testing, anticonvulsants are the mainstay of treatment. The choice of anticonvulsants in elderly patients requires careful evaluation of medical comorbidities, which vary on an individual basis. This subgroup also is more susceptible to adverse effects because of the physiologic changes in the body due to older age, which affect the pharmacokinetics of most anticonvulsants. The ideal drug in this age group should have linear pharmacokinetics, fewer adverse effects, minimal or no drug-drug interactions, no enzyme induction/inhibition, a long half-life, and minimal protein binding, and should be cost-effective. As such, there is no ideal drug for this patient population, although both older- and newer-generation anticonvulsants are used for long-term treatment. Most newer anticonvulsants have the advantage of a favorable pharmacokinetic profile, minimal or no drug-drug interactions, and fewer adverse events, as well as being well tolerated. The older anticonvulsants still are widely used, because the newer anticonvulsants are much more expensive.
Batool F Kirmani; Diana Mungall Robinson; Adeline Kikam; Ekokobe Fonkem; Daniel Cruz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in neurology     Volume:  16     ISSN:  1092-8480     ISO Abbreviation:  Curr Treat Options Neurol     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-04-23     Completed Date:  2014-04-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815940     Medline TA:  Curr Treat Options Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  295     Citation Subset:  -    
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