Page 426 - ILAE_Lectures_2015
P. 426
effects, particularly its effects on bone health (see Chapter 40). Carbamazepine, an enzyme
inducer, is also best avoided as a first option, particularly due to concerns about its potential
effects on bone health.
Whichever drug is used the introductory dose should be low and dose titration should be slow
and cautious. Monitoring for potential side effects should be intensive and due consideration
should be given to the presentation of non-specific side effects of AEDs, e.g. falls, confusion,
incontinence. Therapeutic ranges are less helpful in elderly people.
References
1. SANDER JW, SHORVON SD. Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry 1996;
61(5):433-43.
2. LUHDORF K, JENSEN LK, PLESNER AM. Epilepsy in the elderly: incidence, social function, and disability.
Epilepsia 1986; 27(2):135-141.
3. LOISEAU J, LOISEAU P, DUCHE B et al. A survey of epileptic disorders in southwest France: seizures in
elderly patients. Ann Neurol 1990; 27(3):232-237.
4. ROBERTS MA, GODFREY JW, CAIRD FI. Epileptic seizures in the elderly: I. Aetiology and type of seizure.
Age Ageing 1982; 11(1):24-28.
5. LUHDORF K, JENSEN LK, PLESNER AM. Etiology of seizures in the elderly. Epilepsia 1986; 27(4):458-
463.
6. CAMERON H, MACPHEE GJ. Anticonvulsant therapy in the elderly a need for placebo controlled trials.
Epilepsy Res 1995; 21(2):149-157.
7. SANDER JW, HART YM, JOHNSON AL, SHORVON SD. National General Practice Study of Epilepsy:
newly diagnosed epileptic seizures in a general population. Lancet 1990; 336(8726):1267-1271.
8. ROBERTS RC, SHORVON SD, COX TC, GILLIATT RW. Clinically unsuspected cerebral infarction
revealed by computed tomography scanning in late onset epilepsy. Epilepsia 1988; 29(2):190-194.
9. MARINI C, KING MA, ARCHER JS et al. Idiopathic generalised epilepsy of adult onset: clinical syndromes
and genetics. J Neurol Neurosurg Psychiatry 2003; 74(2):192-196.
10. HOPKINS A, GARMAN A, CLARKE C. The first seizure in adult life. Value of clinical features,
electroencephalography, and computerised tomographic scanning in prediction of seizure recurrence.
LANCET 1988; 1(8588):721-726.
11. HAUSER WA, RICH SS, ANNEGERS JF, ANDERSON VE. Seizure recurrence after a 1st unprovoked
seizure: an extended follow-up. Neurology 1990; 40(8):1163-1170.
12. LUHDORF K, JENSEN LK, PLESNER AM. Epilepsy in the elderly: prognosis. Acta Neurol Scand 1986;
74(5):409-415.
13. RAMSAY RE, RUGGLES K, SLATER JD. Effects of age on epilepsy and its treatment. Results from the VA
cooperative study. Epilepsia 1994; 35 (Suppl 8):91.
14. TALLIS R, CRAIG I, EASTER D. Multicentre comparative trial of sodium valproate and phenytoin in elderly
patients with newly diagnosed epilepsy. Age Ageing 1994; 23 (Suppl 2):5 (Abstract).
15. CRAIG I, TALLIS R. Impact of valproate and phenytoin on cognitive function in elderly patients: results of a
single-blind randomized comparative study. Epilepsia 1994; 35(2):381-390.
16. READ CL, STEPHEN LJ, STOLAREK IH et al. Cognitive effects of anticonvulsant monotherapy in elderly
patients: a placebo-controlled study. Seizure 1998; 7(2):159-162.
17. STEPHEN LJ, BRODIE MJ. Epilepsy in elderly people. Lancet 2000; 355(9213):1441-1446.
18. BRODIE MJ, OVERSTALL PW, GIORGI L. Multicentre, double-blind, randomised comparison between
lamotrigine and carbamazepine in elderly patients with newly diagnosed epilepsy. The UK Lamotrigine
Elderly Study Group. Epilepsy Res 1999; 37(1):81-87.
19. MACPHEE GJ, BRODIE MJ. Drugs in the elderly. Med Int 1992; 101:4258-4263.
20. MACPHEE GJ, BUTLER E, BRODIE MJ. Intradose and circadian variation in circulating carbamazepine and
its epoxide in epileptic patients: a consequence of autoinduction of metabolism. Epilepsia 1987; 28(3):286-
294.
21. HOCKINGS N, PALL A, MOODY J, DAVIDSON AV, DAVIDSON DL. The effects of age on
carbamazepine pharmacokinetics and adverse effects. Br J Clin Pharmacol 1986; 22(6):725-728.
22. LEPPIK IE. Metabolism of antiepileptic medication: newborn to elderly. Epilepsia 1992; 33
Suppl 4:S32-S40.
23. PERUCCA E, GRIMALDI R, GATTI G et al. Pharmacokinetics of valproic acid in the elderly. Br J Clin
Pharmacol 1984; 17(6):665-669.
