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Epilepsy
in the elderly
It is often not possible to recognize
epileptic seizures unambiguously in older
patients; they may be identified as
confusion of unclear etiology, memory
disturbance, or giddiness.
Aura is a typical symptom in young patients,
but is rare in old patients.
Moreover, confusion after a seizure may last
much longer in older patients with epilepsy,
giving the impression of dementia or stroke.
Drug treatment of old patients with epilepsy
is complicated. There has not yet been
enough research on changes in drug
distribution and decreased elimination
through the liver and kidneys in epilepsy in
the elderly.
For this reason, many therapeutic decisions
are based on experience with young
epileptics, together with the knowledge of
the general principles of pharmacotherapy in
age.
As old patients often require different
drugs for a variety of diseases, drug
interactions may occur. Moreover, older
patients react more sensitively to drug side
effects.
The author discusses conventional
antiepileptics, together with their side
effects and interactions.
Nevertheless, many questions cannot be
answered with the current state of knowledge
and the available studies.
In the new edition of Deutsches Ärzteblatt
International (Dtsch Arztebl Int 2009;
106[9]: 135��),
Konrad J. Werhahn of the Epilepsy Center of
Johannes Gutenberg University in Mainz,
Germany, presents the clinical
characteristics of the disease and the
therapeutic options.
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