TREATMENT OF EPILEPSY IN PATIENTS OF “VU LNERABLE” AGE: THE ADOLESCENTS AND THE ELDERLY

Abstract

The incidence of epilepsy is highest in children and in elderly people (over 60 years of age). In about 75% of cases, the first seizures occur before the age of 16 with the maximal occurrence observed before the age of 10 [1]. The problems of diagnosis and treatment of epilepsy in patients of the “transitional” age – adolescents, as well as elderly people – need more attention because these two groups go through the most vulnerable periods of their lives, both psychologically and physiologically. These problems should be approached in the way specific for each age group. For example, there are difficulties in diagnosing a particular form of epilepsy in adolescents; therefore the diagnoses of “unspecified epilepsies” are made. In these cases, the use of wide spectrum antiepileptic agents is recommended. In elderly patients, we often see symptomatic forms of epilepsy in combination with a number of concomitant disorders. Given the age-related changes in pharmacokinetics of antiepileptic drugs, the treatment options for the elderly are quite limited. Here, the medical records of 420 patients (from 3 to 79 years old) diagnosed with various forms of epilepsy were studied. We were interested in patients with “unspecified” forms of epilepsy and the treatments they received. In 17% of cases, the form of epilepsy could not be identified. Levetiracetam and valproate were used most often; as a result of the therapeutic optimization, the volume of carbamazepine-based therapy declined. Among other agents, topiramate, zonisamide, lamotrigine and lacosamide were also in use. In 75% of the studied cases, the treatment with broad-spectrum drugs allowed to control seizures in patients with “unspecified” forms of epilepsy, which indicated the correct choice of therapy.

Keywords

• epilepsy
• adolescents
• elderly patients
• antiepileptic therapy
• therapeutic principles