Strategies for Optimizing Antiepileptic Drug Therapy in Elderly People

Thomas E. Lackner, Pharm.D., FASCP


Pharmacotherapy. 2002;22(3) 

In This Article

Abstract and Introduction

The elderly take more antiepileptic drugs (AEDs) than all other adults. This extensive use directly correlates with an increased prevalence of epilepsy in a growing population of older people, as well as other neuropsychiatric conditions such as neuropathic pain and behavioral disorders associated with dementia and for which AEDs are administered. The agents account for nearly 10% of all adverse drug reactions in the elderly and are the fourth leading cause of adverse drug reactions in nursing home residents. Numerous factors associated with advanced age contribute to the high frequency of untoward drug effects in this population; however, strategies are available to ensure optimal outcomes.

Eleven percent of nursing home residents take an antiepileptic drug (AED), and prescriptions for AEDs for neuropsychiatric conditions other than seizure disorders have increased nearly 2-fold since 1991.[1,2] Widespread therapy with AEDs in elderly people reflects the high prevalence of seizure disorders in this population, together with increasing therapy for nonseizure conditions such as agitation and aggression with dementia, bipolar disorder, neuropathic pain, and essential tremor.[2,3] The drugs may be effective for these conditions, but adverse reactions are common and can be especially problematic in this age group.[4,5,6,7,8] Contributing factors include age-related physiologic changes affecting pharmacokinetics and pharmacodynamics, comorbidities, and therapy with numerous agents that predispose to drug-disease and drug-drug interactions.