Epilepsy in the Elderly

Leppik, Ilo E.

doi:10.1055/s-2002-36650

Cited by 44 publications

(29 citation statements)

References 41 publications

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“…Their outcomes are similar-there is equivalence in efficacy but the newer AEDs are better tolerated [19][20][21][22][23][24]. Therefore, it is not surprising to find that the elderly are placed preferentially on newer AEDs as the elderly have a high incidence of co-morbidities and are frequently treated with polypharmacy [25].…”

Section: Resultsmentioning

confidence: 99%

Levetiracetam use in critically ill patients

et al. 2007

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Section: Resultsmentioning

confidence: 99%

Levetiracetam use in critically ill patients

et al. 2007

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“…11,13 The issue of AED-PDI been identified as a consideration in selecting AEDs for older patients in numerous review articles. 3-6 To our knowledge, this is the first study that has systematically examined the scope of the AED-PDI problem in a geriatric population and further identified the patient characteristics (diagnostic setting, age, comorbidities) associated with an increase risk of AED-PDI. In our study nearly half of all older patients received an AED that interacted with existing, chronic medications.…”

Section: Discussionmentioning

confidence: 99%

“…3-5 These drug-drug interactions may cause AED toxicity or reduce the efficacy of the interacting drug. 6,7 As many of the drugs with potential interactions with AEDS are used to treat hypertension, hyperlipidemia, and coagulation disorders, prolonged exposure to AEDs and potentially interacting drugs (AED-PDI) may be associated with adverse outcomes such as falls/fractures, stroke, myocardial infarction and mortality.…”

Section: Introductionmentioning

confidence: 99%

Choice of Initial Antiepileptic Drug for Older Veterans: Possible Pharmacokinetic Drug Interactions with Existing Medications

Pugh

Vancott

Steinman

et al. 2010

J American Geriatrics Society

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Objectives Identify clinically-meaningful potential drug-drug interactions with antiepileptic drugs (AED-PDI), the AEDs and co-administered drugs commonly associated with AED-PDI, and characteristics of patients with increased likelihood of AED-PDI exposure. Design Five-year retrospective cohort study of veterans with new-onset epilepsy. Setting National VA and Medicare databases. Participants Veterans age 66 years and older with a new diagnosis of epilepsy between October 1, 1999-September 30, 2004 (N=9,682). Measurements We restricted AED-PDI to clinically-meaningful potential drug interactions identified by prior literature review. AED-PDI were identified using participants' date of initial AED prescription and overlapping concomitant medications. Logistic regression analysis identified factors associated with AED-PDI including demographic characteristics, chronic disease states and diagnostic setting. Results AED-PDI exposure was found in 45.5% (4,406/9,682); phenytoin, a drug with many potential drug interactions, was the most commonly prescribed AED. Cardiovascular drugs, lipid-lowering medications and psychotropic agents were the most commonly co-administered AED-PDI medications. Individuals at higher likelihood of AED-PDI exposure had 1) hypertension (OR=1.46, 99% CI 1.24-1.82), 2) hypercholesterolemia (OR=1.40, 99% CI 1.24-1.57) and 3) were diagnosed in emergency or primary care vs. Neurology settings (emergency OR: 1.30 99% CI=1.08-1.58; primary care OR: 1.29 99% CI 1.12-1.49). Conclusion Exposure to AED-PDI was substantial, but less common in epilepsy patients diagnosed in a neurology setting. Because potential outcomes associated with AED-PDI include stroke and myocardial infarction in a population already at elevated risk, clinicians should closely monitor blood pressure, coagulation, and lipid measures to minimize adverse effects of AED-PDI. Interventions to reduce AED-PDI may improve patient outcomes.

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“…8,9 Newer anticonvulsant medications are becoming increasingly more prevalent, although traditional anticonvulsants (eg, phenytoin, carbamazepine, valproic acid) continue to be used in older patients. 10,11 …”

Section: Introductionmentioning

confidence: 99%

A review of the effect of anticonvulsant medications on bone mineral density and fracture risk

Lee

Lyles

Colón‐Emeric

2010

The American Journal of Geriatric Pharmacotherapy

145

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Background Osteoporosis and seizure disorders are common diagnoses in older adults and often occur concomitantly. Objective The goal of this review was to discuss the current hypothesis for the pathogenesis of anticonvulsant-induced bone density loss and the evidence regarding the risk for osteoporosis and fractures in older individuals. Methods A review of the literature was performed, searching in MEDLINE and CINAHL for articles published between 1990 and October 2009 with the following search terms: anticonvulsant OR antiepileptic; AND osteoporosis OR bone density OR fracture OR absorptiometry, photon. Studies within the pediatric population, cross-sectional studies, and studies whose results were published in a language other than English were excluded. Results A search of the published literature yielded >300 results, of which 24 met the inclusion and exclusion criteria and were included in this review. Hepatic enzyme induction by certain anticonvulsant medications appears to contribute to increased metabolism of 25-hydroxyvitamin D to inactive metabolites, which results in metabolic bone disease. There is increasing evidence that anticonvulsant use is associated with a higher risk of osteoporosis and clinical fractures, especially among older agents such as phenobarbital, carbamazepine, phenytoin, and valproate. Several observational studies suggest a class effect among anticonvulsant agents, associated with clinically significant reductions in bone mineral density and fracture risk. The use of anticonvulsant medications increases the odds of fracture by 1.2 to 2.4 times. However, only 2 large-scale observational studies have specifically examined the risk among those aged >65 years. This review also identified a randomized controlled trial whose results suggest that supplementation with high-dose vitamin D may be associated with increased bone mineral density in patients taking anticonvulsant medications. However, no randomized controlled trials investigating therapeutic agents to prevent fracture in this population were identified. Consequently, there are no formal practice guidelines for the monitoring, prevention, and management of bone disease among those taking anticonvulsants. Conclusions Observational studies suggest an association between use of anticonvulsant medications, reduced bone mineral density, and increased fracture risk. Randomized clinical trials are needed to guide the management of bone disease among those who use anticonvulsants.

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Epilepsy in the Elderly

Cited by 44 publications

References 41 publications

Levetiracetam use in critically ill patients

Levetiracetam use in critically ill patients

Choice of Initial Antiepileptic Drug for Older Veterans: Possible Pharmacokinetic Drug Interactions with Existing Medications

A review of the effect of anticonvulsant medications on bone mineral density and fracture risk

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