epilepsy in elderly neelima thakur md

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EPILEPSY IN ELDERLY NEELIMA THAKUR MD.

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EPIlepsy in elderly Neelima Thakur MD. EPIlepsy in elderly. Research shows that the incidence of epilepsy is higher in the elderly . Epilepsy was believed to be predominantly a childhood disorder. - PowerPoint PPT Presentation

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Page 17: EPIlepsy in elderly Neelima Thakur MD

PROVOKED SEIZURES Common causes

acute alcohol withdrawal metabolic and electrolyte disturbances

Hyponatremia Hypocalcemia Hypomagnesemia

Infections systemic CNS.

Drugs - commonly prescribed to elderly. Tramadol Antipsychotics Antidepressants (particularly tricyclics) Antibiotics(quinolones and macrolide) Theophylline, levodopa, thiazide diuretics and even the herbal

remedy, ginkgo biloba

Page 35: EPIlepsy in elderly Neelima Thakur MD

TREATMENT OF EPILEPSY

Older people who present with a first unprovoked seizure are more likely to develop seizure recurrence than are younger adults.

Cause identified in more than 60% of elderly people with epilepsy.

Page 41: EPIlepsy in elderly Neelima Thakur MD

THE CLINICAL BENEFITS AND CAUTIONS OF ANTIEPILEPTIC DRUG USE IN THE ELDERLY. Older AEDs

Benzodiazepines Acute use Status epilepticus Idiosyncratic reactions, psychosis and sedation

Phenobarbital Broad spectrum Once-daily dosing Significant adverse event profile Requires very slow dose titration

Phenytoin Acute use Status epilepticus 'Zero-order' kinetics, so care is needed in making dose changes Enzyme inducer Interacts with digoxin and warfarin

Carbamazepine Effective in partial-onset seizures Enzyme inducer so interacts with other AEDs, some antibiotics and warfarin Hyponatremia can occur, especially with diuretics

Sodium valproate Effective in generalized-onset seizures Enzyme inhibitor. . Few interactions Ataxia and tremor may be troublesome in elderly Reversible extrapyramidal symptoms

Page 42: EPIlepsy in elderly Neelima Thakur MD

NEWER AEDS Lamotrigine (Lamictal)

Effective in partial-onset seizures and generalized seizures. Mood stabilizer

Requires slow-dose titration to avoid serious allergic rash.

Very slow titration especially in patients already taking sodium valproate

Oxcarbazepine (Trileptal) Few interactions. Well tolerated Hyponatremia can occur, especially with diuretics

Levetiracetam (Keppra) Inert metabolites Lack of drug interactions Mood and behavioral disturbances occur occasionally

Topiramate (Topamax) Seizures and migraine prophylaxis. Requires slow dose titration Can cause weight loss and cognitive problems .

Zonisamide (Zonegran) Better side effect profile compared to Topamax.

Page 43: EPIlepsy in elderly Neelima Thakur MD

NEWER AEDS

Gabapentin (Neurontin) Also used for neuropathic pain. Limited efficacy in epilepsy. Can be used in liver dysfunction Can cause dizziness, sedation and weight gain

Pregabalin (lyrica) Also Used for neuropathic pain Can be used in liver dysfunction Lack of drug interactions Can cause dizziness and weight gain, motor and cognitive

slowing Lacosamide (Vimpat)

Partial Epilepsy Increased risk of PR interval elongation on electrocardiogram. Contraindicated in second- and third-degree AV block

Page 46: EPIlepsy in elderly Neelima Thakur MD

SUMMARY Development of epilepsy is common in later life. The number of elderly with epilepsy will rise

further. placing an increasing burden on healthcare resources

Epilepsy can have a profound physical and psychological impact in old age, with a substantial negative effect on quality of life

Be aware of Mimics Most elderly people with epilepsy can remain

seizure-free with appropriate treaments. Attention should be paid to side effects and

potential for drug-drug interactions

Page 47: EPIlepsy in elderly Neelima Thakur MD

HAPPILY SEIZURE FREE EVER AFTER!!