Elders with Epilepsy

Collins, Nancy; Shapiro, Rita; Ramsay, R. Eugene

doi:10.1016/j.mcna.2006.06.002

Cited by 31 publications

(33 citation statements)

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“…These findings were particularly unexpected because we found only a small number of patients (9/109) who presented status epilepticus, a condition for which intravenous medications are required, and could be one of the reasons for phenytoin administration during hospitalization. Our results are similar to other published studies in which phenytoin was the most frequently prescribed AED for elderly people with epilepsy (EPWE), despite its saturation kinetics and high potential interaction profile 4,12,13 . These studies were performed previously or very soon after the earliest published guidelines advising the use of the second generation AEDs for the treatment of elders with epilepsy.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, the clearance of most first and second generation AEDs is reduced by about 20-40% in elderly patients compared with young adults 18 . Drugs that are renally cleared, such as gabapentin, pregabalin and levetiracetam are desirable because this results in fewer drug-drug interactions 13 . In our study the patients were monitored clinically and merely 1.8% / 2 of them had measurement of serum AED concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…For elderly patients treated with phenytoin, a highly protein binding AED, who have decreased serum albumin concentration, it is suggested that measuring free phenytoin levels may be a better indicator of efficacy and toxicity than total concentrations 6 . Moreover, phenytoin nonlinear pharmacokinetics and the capacity to induce or inhibit its metabolism can produce concentrations which may vary from sub therapeutic to toxic for some patients 13 . Seizures induced by drugs are associated with use of comedications, high doses, parenteral administration and comorbidities 4 .…”

Section: Discussionmentioning

confidence: 99%

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Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil

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Costa

et al. 2014

Arq. Neuro-Psiquiatr.

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Epilepsy is very prevalent among elderly inpatients and treatment is far from ideal. Objective: To analyze prescribing patterns of antiepileptic drugs (AEDs) for hospitalized elderly with epilepsy, their relations with comorbidities and comedications. Method: We assessed prescription regimen of elderly patients that were under AED use for treatment of epileptic seizures, during hospitalization. One hundred and nine patients were enrolled. AED regimen was categorized into two groups: Group 1 defined as appropriate (carbamazepine, oxcarbazepine, valproic acid, gabapentin, clobazan and lamotrigine) and Group 2 as inappropriate (phenytoin and phenobarbital). Results: We found 73.4% of patients used inappropriate AEDs (p,0.001). Monotherapy was prescribed for 71.6% of patients. The most common comorbidity was hypertension. Potentially proconvulsant drugs as comedications were used for nearly half of patients. Conclusion: Inappropriate AED therapy was commonly prescribed regimen for elderly inpatients. Some recommendations are discussed for a better care of elderly inpatients with epilepsy.Keywords: antiepileptic drugs, elderly, epilepsy, epileptic seizures. RESUMOEpilepsia é frequente entre idosos hospitalizados e o tratamento costuma ser aquém do ideal. Objetivo: Analisar os padrões de prescrição de drogas antiepilépticas para idosos hospitalizados com epilepsia, bem como sua relação com comorbidades e comedicações. Método: Revisamos os prontuários de pacientes idosos internados com diagnóstico de epilepsia e que estavam em uso de droga antiepiléptica (DAE) durante o período de hospitalização. Cento e nove pacientes foram incluídos no estudo. O regime de DAE foi categorizado em dois grupos: Grupo 1, definido como apropriado (carbamazepina, oxcarbazepina, ácido valpróico, gabapentina, clobazam e lamotrigina) e Grupo 2, como inapropriado (fenitoína e fenobarbital). Resultados: 73,4% dos pacientes usaram DAE inapropriadas (p,0,001). Regime de monoterapia foi usado por 71,6% dos pacientes. Hipertensão arterial foi a comorbidade mais frequente. Medicações concomitantes potencialmente proconvulsivantes foram usadas por quase metade desta população. Conclusão: Regime de droga antiepiléptica inapropriada foi o mais utilizado em pacientes idosos internados. São discutidas algumas recomendações para melhor cuidado ao paciente idoso hospitalizado com epilepsia.Palavras-chave: drogas antiepilépticas, idosos, epilepsia, crises epilépticas.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil

Assis

Nascimento

Costa

et al. 2014

Arq. Neuro-Psiquiatr.

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“…[15] En sık görülen nöbet tipi sırasıyla kompleks parsiyel, jeneralize tonik klonik ve basit parsiyel nöbetlerdir. [16,17] Bizim olgularımızda en sık görülen nöbet tipi sekonder jeneralize tonik klonik nöbetler iken sadece bir olguda kompleks parsiyel tipte nöbet gözlemlendi. …”

Section: Gereç Ve Yöntemunclassified

Experiences in an Epilepsy Polyclinic: Epilepsy in the Elderly

Özkan¹

2015

Epilepsi

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SummaryObjectives: Epilepsy is one of the most common serious neurological disorders in the elderly. In this study the demographic and clinical features, etiological factors, seizure types and response ratios to treatment are presented for a group of patients aged 60 years and over diagnosed with epilepsy.Results: Twenty-five patients aged 60 years and over who applied to the epilepsy polyclinic were retrospectively investigated.Results: Average patient age was 75.0±7.1 years and average disease duration was 2.32±1.8 years. Sixteen patients were male and 9 female. Among the patients, cerebrovascular disease (17 patients), brain tumor (1 patient), arachnoid cyst (1 patient), aneurysm (1 patient) and myocardial infarction (1 patient) were considered as the underlying factors in seizure development. In the remaining 4 cases, no etiological cause was determined. Seizure types were; secondary generalized tonic-clonic seizure (20 patients), simple partial seizure (2 patients), status epilepticus seizure (2 patients), and complex partial seizure (1 patient). EEG findings were abnormal in 32% of the patients (n=8). When evaluated for treatment, 18 patients received monotherapy; 6 patients used double, and 1 patient used triple drugs. The follow-up period in 21 cases was without seizure. Conclusion:In the study, the most common etiological cause of epilepsy seen in the elderly was cerebrovascular disease. Seizure type was mainly secondary generalized tonic-clonic. The patients responded well to monotherapy and prognosis was improved.

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“…10 The aim of this study was to describe the characteristics of patients with epilepsy which began after the age of 60.…”

Section: Introductionmentioning

confidence: 99%

Caracterização da epilepsia com início após os 60 anos de idade

Bruscky

Leite

Correia

et al. 2016

Rev. bras. geriatr. gerontol.

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Introduction: Despite its high incidence, the characteristics of epilepsy in elderly patients have not yet been widely studied. The clinical presentation of the disease is mostly atypical and findings from complementary examinations provide little help with diagnosis. Few reports have characterized this group of individuals. Objective: To describe the characteristics of patients with epilepsy with onset after 60 years of age. Method: A descriptive study of a case series was designed. For this purpose, 50 patients diagnosed with epilepsy with onset after 60 years of age, treated at the outpatient epilepsy clinic of the Hospital da Restauração (Recife-PE), were consecutively assessed. Results: The 50 patients included in the study had an average age of 75.3 (±13) years, 30 (60.0%) were female and 20 (40.0%) were male. The average age at the first seizure episode was 72.5 (±11.5) years. Focal epilepsy seizures were the most predominant (83.8%). The occurrence of status epilepticus was low in this group (4.0%). Symptomatic epilepsy was the most frequent type, and most of the causes were of vascular etiology (43.0%). Carbamazepine was most commonly used for treatment, and the patients responded well to low-dose monotherapy. Electroencephalograms displayed normal results in many cases (50.0%), and neuroimaging showed nonspecific findings for most individuals (83.0%). Conclusion: Epilepsy in elderly patients is predominantly focal and symptomatic, with a low occurrence of status epilepticus and good therapeutic response. The encephalogram and neuroimaging results are frequently nonspecific.

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Elders with Epilepsy

Cited by 31 publications

References 31 publications

Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil

Antiepileptic drugs patterns in elderly inpatients in a Brazilian tertiary center, Salvador, Brazil

Experiences in an Epilepsy Polyclinic: Epilepsy in the Elderly

Caracterização da epilepsia com início após os 60 anos de idade

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