New anti-seizure medication for elderly epileptic patients

ABSTRACT

Introduction: Epilepsy treatment in older people requires specific consideration owing to more physical co-morbidities, the risk of drug-to-drug interactions through polypharmacy, and differences in pharmacodynamics and pharmacokinetics. There are many ‘newer’ antiepileptic drugs (AEDs) widely used for various seizure types and seizure disorders. However, there is limited specific evidence for the efficacy, safety, and tolerability of these treatments in the elderly population.

Areas covered: This review summarises the current most robust evidence available for the use of the newer AEDs belonging to generation two and three in elderly people with epilepsy. The article provides practical evidenced based clinical information to help prescribers choose the most appropriate AED from the drugs discussed.

Expert opinion: Diagnosing new onset epilepsy in the elderly population requires specialist assessment. Treatment plans need to be tailored to accommodate an individual’s co-morbidities, concurrent medications, and general health status. To date, few clinical investigations consider the elderly population specifically despite the increased risk factors. There is a need for large quality trial data to assess the impact of the newest AEDs on seizure control and quality of life in this population with complex needs.

KEYWORDS:

• Anti-seizure medication
• elderly
• epilepsy
• prescribing in elderly
• seizures in elderly

Article highlights

• There is limited robust evidence for the efficacy, safety, and tolerability of ‘newer’ AED treatments in the complex elderly population, which makes it challenging to provide person-centered care.

• Elderly people with epilepsy have more physical co-morbidities, increased risk of drug-to-drug interactions through polypharmacy, and differences in pharmacodynamics and pharmacokinetics.

• A practical traffic light system has been developed to help guide prescribers when making decisions over which AED to prescribe.

• Lamotrigine has the best evidence for safety, tolerability, and efficacy in this population. Levetiracetam is also reasonably well studied.

• There is some evidence to support the safety, tolerability, and efficacy of topiramate, zonisamide, perampanel, lacosamide, oxcarbazepine, and eslicarbazapine.

This box summarizes key points contained in the article.

Declaration of interest

R Shankar is a stakeholder of the ‘SUDEP and Seizure Safety Checklist’. Furthermore, Dr Shankar is a key stakeholder of EpsSMon. Finally, Dr Shankar has received institutional and research support and personal fees from LivaNova, UCB Pharma, Eisai, Special Products, Bial and Desitin all outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.