Epilepsy in the elderly

Abstract

The elderly, often defined as those 65 years or older, are the most rapidly growing segment of the population, and onset of epilepsy is higher in this age group than in any other. This paper reviews recent developments, including a new proposed definition of epilepsy, a transgenic mouse model of Alzheimer's disease that exhibits complex partial seizures, evidence that the highest incidence of epilepsy may occur after admission to a nursing home, a challenge to the vitamin D hypothesis of osteoporosis associated with antiepileptic drugs (AEDs), evidence that the genetic complement of hepatic isoenzymes is more predictive of metabolic rate than age, and data showing that there is considerable variability in serum levels of AEDs in many nursing home residents during constant dosing conditions.

Figure 1. Variablity of phenytoin concentrations in elderly nursing home residents

The subjects were included in the figure if: they had no change in phenytoin dose over all of the measurements, they were on no medications which would alter phenytoin clearance and had standing orders for routine serial phenytoin measurements. Each vertical column incorporates the concentrations from a single subject. Subjects are arranged in order of ascending age. Levels in each subject varied randomly over time. Note that although many subjects had large variations over time, some had little fluctuation. Data re4garding medical condition of subjects was not available. This problem is now being investigated by a prospective study to determine the causes and consequences of fluctuating levels. Used by permission from authors and publisher.