The treatment of epilepsy in younger and older adults: Demographic differences and prescribing patterns of anti-seizure medications in Canada

Haris, Asad; Bachour, Kenan; Hopkins, Robert; Tarride, Jean-Eric; Keezer, Mark R

doi:10.1016/j.eplepsyres.2022.106941

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…Anti-seizure medication type (enzyme-inducing vs nonenzyme-inducing) and number were not associated with frail and robust subgroups in the study. Up to two-thirds of older adults receive enzyme-inducing ASMs, 16 which negatively impact bone- and cardiovascular health. It is conceivable that within an individual with epilepsy, a combination of epilepsy factors, chiefly age of onset, seizure control, and ASM use, may have a bidirectional relationship with frailty, thereby blurring a clear cause-and-effect relationship.…”

Section: Commentarymentioning

confidence: 99%

Start Low and Go Slow: The General Principle of Managing Older Adults With Epilepsy Finds Robust Support From Frailty

Punia

2023

Epilepsy Curr

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Section: Commentarymentioning

confidence: 99%

Start Low and Go Slow: The General Principle of Managing Older Adults With Epilepsy Finds Robust Support From Frailty

Punia

2023

Epilepsy Curr

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The implications of frailty in older adults with epilepsy

Hashmi,

Sachdeva,

Sindhu

et al. 2024

Epilepsia Open

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Older adults constitute a large proportion of people with epilepsy (PWE) due to the changing demographics worldwide and epilepsy's natural history. Aging‐related pathophysiological changes lower the tolerance and increase our vulnerability to stressors, which manifests as frailty. Frailty is closely associated with adverse health outcomes. This narrative review examines the interplay between frailty and epilepsy, especially in older adults, emphasizing its clinical implications, including its role in managing PWE. Mechanistically, frailty develops through complex interactions among molecular and cellular damage, including genomic instability, mitochondrial dysfunction, and hormonal changes. These contribute to systemic muscle mass, bone density, and organ function decline. The concept of frailty has evolved from a primarily physical syndrome to include social, psychological, and cognitive dimensions. The “phenotypic frailty” model, which focuses on physical performance, and the “deficit accumulation” model, which quantifies health deficits, provide frameworks for understanding and assessing frailty. PWE are potentially more prone to developing frailty due to a higher prevalence of risk factors predisposing to frailty. These include, but are not limited to, polypharmacy, higher comorbidity, low exercise level, social isolation, low vitamin D, and osteoporosis. We lack commercial biomarkers to measure frailty but can diagnose it using self‐ or healthcare provider‐administered frailty scales. Recent attempts to develop a PWE‐specific frailty scale are promising. Unlike chronological age, frailty is reversible, so its management using multidisciplinary care teams should be strongly considered. Frailty can affect antiseizure medication (ASM) tolerance secondary to its impact on pharmacokinetics and pharmacodynamics. While frailty's effect on seizure control efficacy of ASM is poorly understood, its undoubted association with overall poor outcomes, including epilepsy surgery, behooves us to consider its presence and implication while treating older PWE. Incorporation of frailty measures in future research is essential to improve our understanding of frailty's role in PWE health.Plain Language SummaryFrailty is the declining state of the human body. People with epilepsy are more prone to it. It should be factored into their management.

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Trends in enzyme-inducing antiseizure medication use: A retrospective analysis among adults with epilepsy

Gandelman-Marton,

Theitler

2024

Epilepsy & Behavior

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The treatment of epilepsy in younger and older adults: Demographic differences and prescribing patterns of anti-seizure medications in Canada

Cited by 3 publications

References 36 publications

Start Low and Go Slow: The General Principle of Managing Older Adults With Epilepsy Finds Robust Support From Frailty

Start Low and Go Slow: The General Principle of Managing Older Adults With Epilepsy Finds Robust Support From Frailty

The implications of frailty in older adults with epilepsy

Trends in enzyme-inducing antiseizure medication use: A retrospective analysis among adults with epilepsy

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