Antiseizure Medications in Older Adults with Epilepsy: Considerations in Pharmacology, Safety, Tolerability, and Effectiveness of Newer Agents - PubMed
3 days ago
- #pharmacology
- #epilepsy
- #geriatrics
- Older adults with epilepsy are underrepresented in clinical trials despite being one of the fastest-growing populations with the condition.
- Antiseizure medication selection in older adults is complicated by multimorbidity, polypharmacy, age-related changes in renal and hepatic function, and vulnerability to adverse effects like falls and cognitive impairment.
- Tolerability and quality-of-life considerations often play a decisive role in treatment selection for older adults, as many antiseizure medications have comparable efficacy.
- Newer antiseizure medications (e.g., lacosamide, brivaracetam, cenobamate) show favorable efficacy and tolerability at lower doses in older adults, though falls, dizziness, and neuropsychiatric effects can be dose-limiting.
- Intranasal benzodiazepine rescue therapies offer practical advantages for seizure clusters, but data specific to older adults are limited.
- Special considerations include renal and hepatic impairment, osteoporosis, anticoagulation, chemotherapy, and populations with dementia, post-stroke epilepsy, tumor-related epilepsy, and depression.
- Lower starting doses, slower titration schedules, and avoidance of enzyme-inducing antiseizure medications are recommended for older adults.
- Future studies should stratify by frailty, cognitive status, and living environment to better inform individualized, tolerability-focused epilepsy care in older adults.