Epilepsies in the elderly

Abstract

The incidence of epileptic seizures and epilepsies in the elderly (over the age of 60) rises continuously with age. The annual incidence rate is 60- 70 per 100 000 inhabitants. The most frequent causes are cerebrovascular diseases followed by brain tumors, metabolic-toxic disorders, head trauma, dementias and inflammatory diseases of the central nervous system. Approximately a quarter up to a third of all cases cannot be explained etiologically. The most frequent seizure type are focal seizures with or without generalization. Epileptic seizures occur more often after cerebral hemorrhages than after cerebral infarctions. Early seizures are prognostically rather disadvantageous. Epileptogenic brain tumors are above all malignant glioma, benign astrocytomas, meningiomas and metastases. The most epileptogenic regions of the brain are the frontal brain and the temporal lobes. Amongst metabolic-toxic causes drugs are to be considered especially as triggers of seizures. In Alzheimer's disease epileptic seizures occur mostly at an advanced age. As a rule, pharmacotherapy starts after the 2nd seizure. We should strive to use monotherapy with the drugs of first choice such as carbamazepine and valproat but we should be careful with phenytoin and barbiturates. In future the new substances such as lamotrigene, gabapentine and vigabatrine will be used more commonly. The altered pharmacodynamics of antiepileptics in the old age is an important factor.