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Review: Treating Older Adults With Epilepsy

December 03, 2017

One of the presentations at the third poster session in the exhibit hall on December 4th, will be displayed by Nastasija Lezaic (Université de Montréal, Montreal, Canada) and colleagues on the medical treatment of epilepsy in older adults.

As older adults represent a rapidly growing portion of the population, professionals will increasingly attend older individuals with epilepsy and will need to account for physiological changes, medical comorbidities, and co-medications when choosing antiepileptic drugs (AEDs). Lezaic and co-presenters performed a systematic review to evaluate the efficacy and tolerability of AEDs in older adults with epilepsy.

Authors identified 3925 eligible abstracts and titles, resulting in 256 full-text articles containing 10 trials, a total of 938 subjects, and evaluating eight AEDs. Some of their key findings are listed below:

  • Lamotrigine trended towards being better tolerated than carbamazepine regular and sustained-released in two small-scale studies, while one large-scale study showed statistically significant better tolerability and seizure-freedom for lamotrigine.
  • Individuals receiving levetiracetam were more likely to be seizure-free as compared to lamotrigine but also trended towards suffering from more side effects.
  • Older adults with dementia treated with levetiracetam demonstrated improved cognitive performance when compared with phenobarbital which occasioned significant negative cognitive effects.
  • In an unpublished study of older individuals with focal refractory epilepsy, zonisamide was possibly more effective (effect not statistically significant) than placebo but also possibly associated with more side effects.

Presenters concluded saying, “There is some evidence that lamotrigine and levetiracetam have similar efficacy and better tolerability in the elderly when compared with older AEDs such as carbamazepine. Evidence exists to support the use of brivaracetam, perampanel, and topiramate.” But they noted that more data is needed to ascertain optimal treatments for older adults. (Abstract 3.272)

—Amanda Del Signore

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