Challenges in the pharmacological management of epilepsy and its causes in the elderly

Ferlazzo, Edoardo; Sueri, Chiara; Gasparini, Sara; Aguglia, Umberto

doi:10.1016/j.phrs.2016.02.013

Cited by 49 publications

(51 citation statements)

References 81 publications

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“…PSE mainly affects the elderly; hence, physicians should consider the peculiar pharmacodynamics and pharmacokinetics of antiepileptic drugs (AEDs) in this population, as well as the coexistence of different pathologies and, therefore, interactions with concomitant treatments. Moreover, the elderly are more vulnerable to the adverse effects of drugs and the titration of the AEDs must take into account their narrow therapeutic range (“start slow and go slow”) . In general, PSE has a good prognosis, being well controlled by AEDs.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the elderly are more vulnerable to the adverse effects of drugs and the titration of the AEDs must take into account their narrow therapeutic range ("start slow and go slow"). 27 In general, PSE has a good prognosis, being well controlled by AEDs. Indeed, an observational study by Semah et al 28 evaluated seizure frequency during 1-7 years in a cohort of 1,148 outpatients with focal epilepsy and MRI evidence of brain abnormalities.…”

Section: General Considerationsmentioning

confidence: 99%

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Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta‐analysis of risk factors

et al. 2016

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SUMMARYObjective: Seizures may occur in close temporal association with a stroke or after a variable interval. Moreover, epilepsy is often encountered in patients with leukoaraiosis. Although early post-stroke seizures have been studied extensively, less attention has been paid to post-stroke epilepsy (PSE) and to epilepsy associated with leukoaraiosis (EAL). The aim of this paper is to review data concerning pathophysiology, prognosis, and treatment of PSE and EAL. Methods: We performed an extensive literature search to identify experimental and clinical articles on PSE and EAL. We also conducted a systematic review of risk factors for PSE and EAL among eligible studies. Results: PSE is caused by enhanced neuronal excitability within and near the scar. The role played by white matter changes in EAL remains to be elucidated. Meta-analysis showed that cortical involvement (odds ratio [OR]

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Section: Resultsmentioning

confidence: 99%

Section: General Considerationsmentioning

confidence: 99%

Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta‐analysis of risk factors

et al. 2016

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“…Many patients, particularly the elderly, are more sensitive to central nervous system related adverse effects of AEDs, such as somnolence and cognitive impairment [11] , further compromising effective seizure control.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and predictive biomarkers of drug resistant epilepsy -- study in Georgia

Alkhidze¹,

Lomidze²,

Kasradze³

et al. 2017

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Aim:The authors conducted a case-control study to estimate predictive factors for timely identification of patients at higher risk for developing drug resistant epilepsy. Methods: The retrospective case-control study was conducted among people diagnosed as having drug resistant epilepsy (cases) and their controls, identified as having drug-responsive seizures. All participants were admitted to the tertiary Epilepsy Center at the Institute of Neurology and Neuropsychology (Tbilisi, Georgia) during 2011. The data on demographic features and disease characteristics were analyzed. Multiple logistic regression analysis was used to identify independent risk factors for development of intractable epilepsy. Results: A total 334 patients were identified; 84 (34%) met the criteria for drug resistant epilepsy. One hundred and sixty-four age-and gender-matched controls with drug-responsive epilepsy were identified. Relative to the control group, the drug resistant seizure group had increased frequency of perinatal pathology (24% vs. 12%), febrile seizures (22% vs. 12%), seizure frequency at disease manifestation (62% vs. 19%), occurrence of convulsive seizures (84% vs. 70%), electroencephalo-graph (EEG) epileptiform discharges (94% vs. 77%), polytherapy (90% vs. 12%), multilobar lesions (30% vs. 16%), hippocampal sclerosis (18% vs. 5%), and malformations of cortical development (8% vs. 2%). Multivariate analysis indicated four factors with independent predictive value for development of intractable epilepsy: frequency of seizure, polymorphism of seizure, polytherapy, and epileptiform EEG abnormalities. Original ArticleThis is an open access article distributed under the terms of the Creative Commons AttributionNonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. 192The presence of all four factors in combination resulted in a 98% of probability of developing drug resistant epilepsy. Conclusion: Several factors appear to have prognostic value in identifying the risk for drug resistant epilepsy. These factors may prove useful in non-specialized health care settings for timely identification of individuals with elevated risk for drug resistant epilepsy. However, retrospective design and possible recall bias must be considered when interpreting or extrapolating these results.

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“…Moreover, data from another retrospective study 4 confirm that drug resistance is rare (5%) among patients with PSE. Finally, the chance to achieve seizure freedom with low doses of antiepileptic drugs in most patients with late-onset epilepsy (including PSE) 5 supports the notion of a favorable prognosis of this condition. In conclusion, we believe that the evidence from clinical trials and observational studies is adequate to conclude that PSE has a good prognosis when compared to other forms of focal epilepsy.…”

Section: To the Editorsmentioning

confidence: 72%

Response to Comment on Epilepsy in cerebrovascular disease: Review of experimental and clinical data with meta‐analysis of risk factors

2017

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Challenges in the pharmacological management of epilepsy and its causes in the elderly

Cited by 49 publications

References 81 publications

Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta‐analysis of risk factors

Epilepsy in cerebrovascular diseases: Review of experimental and clinical data with meta‐analysis of risk factors

Characteristics and predictive biomarkers of drug resistant epilepsy -- study in Georgia

Response to Comment on Epilepsy in cerebrovascular disease: Review of experimental and clinical data with meta‐analysis of risk factors

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