Treatment
• Medication side effects: Elderly individuals are more likely to side effects from a seizure medication than a younger individual.
- The body’s metabolism slows during aging. As a result higher medication levels and by metabolic byproducts may be seen after each dose, which will cause more side effects
- An elderly person’s stomach may not be consistent in absorbing a medication. This will result in unpredictable levels on a day to day basis.
- Elderly individuals are more prone to certain side effects from seizure medication like dizziness, and for some medications like oxcarbazepine and carbamazepine, disturbance of blood salt balance.
• Interactions with other medications
- Most elderly individuals take 2-3 medications on a daily basis, and one in five takes greater than 5 medications. This can result in multiple issues.
* Many seizure medications share the same metabolic pathways in the liver as many commonly used medications. When medications share the same pathway there is a risk of interaction. Seizure medication can raise or lower the levels of life-saving medication, and vice versa. For example carbamazepine will lower Coumadin levels, which is taken by patients with heart conditions to prevent clots and strokes.
* The burden of side effects is directly related to the number of medications taken. For example, an elderly individual, already prone to balance issues, who takes excessive medications, is more likely fall. Falls in the elderly are not trivial and may result in fractures of fragile bones resulting in prolonged and costly hospitalization and even death.
* An elderly person who is taking several medications is more likely to take their medication incorrectly and miss their seizure medication or other life-preserving medication.
- Proper care of elderly individuals with epilepsy to discuss with the doctor
* First the diagnosis needs to be correct. If necessary, video-EEG might be required to capture and classify spells to determine if they are truly seizures and require treatment
* The proper medication should be selected. Medications such as lamotrigine and leviteracitam have been shown to be safe and effective in the elderly with fewer side effects than older seizure medications such as carbamazepine.
* The minimum dose and number of seizure medications should be prescribed.
* If necessary blood levels and blood chemistry should be followed carefully
* Individuals with memory problems should consider a pillbox or alarm clock to help remember to take medication and appointments
* See section on preparing a safe home. This is important in the elderly because of falls (discussed above).
* Epilepsy surgery has been shown to be safe and effective in the elderly. This treatment option should be considered in elderly individuals who fail to respond to conventional medical treatment. Tumors that cause epilepsy may also respond to surgery.