Epilepsy in the elderly

INTRODUCTION: Epilepsy is a frequent pathology in the elderly, but its aetiology, clinical presentation and prognosis are different to those seen in younger patients. DEVELOPMENT: Beyond a certain age physiological modifications take place in the metabolism that alter the pharmacokinetics of the antiepileptic drugs (AED) and increase the risk of pharmacological interactions, which is already higher in these patients owing to the frequency of polypharmacy. Moreover, elderly patients are especially sensitive to certain side effects of AED, such as cognitive disorders, osteoporosis or weight increase. Since the efficacy of the more important AED is a priori quite similar and the epilepsies we have to deal with at this age usually have a good prognosis, the choice of AED will depend more on their pharmacokinetics and their potential to trigger certain side effects than on their effectiveness. CONCLUSIONS: The ones with the most favourable pharmacokinetic profile are levetiracetam and pregabalin, followed oxcarbazepine and lamotrigine. Additionally, these drugs generally have few cognitive effects, do not give rise to osteoporosis and, with the exception of pregabalin, do not alter the patient's weight, all of which makes them first choice drugs for the treatment of epilepsy in the elderly.